Managing Patients with Prolonged Recovery Following Concussion

Phillips, Mary Viola; Reddy, Cara Camiolo

doi:10.1016/j.pmr.2015.12.005

Cited by 9 publications

(4 citation statements)

References 139 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The discrepancy with our finding may reflect the concern that typical postconcussive symptom inventories are not as reliable in younger children [30,31] and/or that in a clinical setting caregivers and providers identify other longer‐lived changes after injury which impact clinical decision‐making. Unlike recent reports of older youth (mean age 14 years) with sports‐related concussion [7,20], female gender was not associated with longer time to discharge in our sample of younger children with concussion of any etiology. Despite findings in previously reported cohorts, child and parent history variables [28,32,33] and history of previous concussions [34,35] were not related to TTD within our sample, although report of previous concussions was very low in our sample.…”

Section: Discussioncontrasting

confidence: 99%

“…Given that postconcussive symptoms overlap with symptoms reported by youth without concussion but with other diagnoses (eg, migraines, mental health disorders, attention-deficit hyperactivity disorder and learning disabilities) [19], identifying when children have recovered from concussion can be challenging. This has led to the recommendation that this population be managed by clinicians whose skill sets include evaluation of overlapping syndromes and underlying contributing factors [20]. Recent literature has highlighted the importance of behavioral health services [21], and particularly cognitive restructuring [22], for preventing and addressing persisting symptoms after childhood concussion.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Course of Concussion Recovery in Children 6‐12 Years of Age: Experience From an Interdisciplinary Rehabilitation Clinic

Risen

Reesman

Yenokyan

et al. 2017

PM&R

View full text Add to dashboard Cite

Background Current concussion evidence is largely derived from teenagers and adults. Concussion in younger children occurs within the context of neuro-maturation, with differing age-based pathophysiological responses to injury. Therefore our current understanding of concussion in older children and adults is unlikely to directly apply to younger children. Objective To describe patient variables, clinical course, and factors associated with time to discharge from concussion care in children 6 – 12 years of age with concussion treated in an interdisciplinary rehabilitation-based concussion clinic. Design Retrospective chart review. Setting Interdisciplinary concussion clinic at an academically-affiliated rehabilitation center. Patients Children aged 6 – 12 years (n= 105; mean 10.8 years of age, 70% male) seen within 60 days of concussive injury. Main Outcome Measurements Descriptive statistics explored demographic, injury, and clinical features. The primary outcome measure, time to discharge from concussion care, was estimated using survival-analysis methods based on the date of discharge from the clinic. Multivariate models were used to examine factors associated with longer time to discharge. Results Median time to discharge was 34 days post-injury (range 5–192 days); 75% of children were discharged within 60 days of injury. A minority reported persisting symptoms at discharge. Younger age and increased symptom burden at initial evaluation predicted longer time to discharge. Conclusions While children 6–12 years old treated in a specialty concussion clinic show variability in time to discharge from concussion care, most were discharged within 2 months following injury. Risk factors for prolonged recovery, such as younger age and higher symptom burden at initial visit, can be used when counseling families and planning interventions. There may be varying contributions, including psychosocial stressors, to ongoing symptoms in children who experience persisting symptoms after other concussion-related concerns have resolved. Future work focused on the subset of children who report persisting symptoms will be useful for developing an evidence base related to their care.

show abstract

Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Course of Concussion Recovery in Children 6‐12 Years of Age: Experience From an Interdisciplinary Rehabilitation Clinic

Risen

Reesman

Yenokyan

et al. 2017

PM&R

View full text Add to dashboard Cite

show abstract

“…Adjusted odds ratios (OR) for protracted recovery were derived from a logistic regression model, in which the outcome was normal (≤ 21 days) or protracted (> 21 days) recovery [ 37 – 39 , 48 , 49 ]. Individual predictors were systematically removed from the model if they did not significantly contribute to model performance ( p < 0.05).…”

Section: Methodsmentioning

confidence: 99%

Association between days for concussion recovery and initial specialty clinic evaluation within 48 hours

Mathew,

Caze,

Price

et al. 2024

BMC Sports Sci Med Rehabil

View full text Add to dashboard Cite

Background Researchers have highlighted the importance of early access to concussion care within one week of injury in reducing recovery times. However, a persisting question for concussion researchers is “just how early is important?” The purpose of this study was to examine differences in recovery time as predicted by the number of days elapsed since injury (DSI) to initial evaluation among patients who had access to a specialty concussion clinic within seven days. We hypothesized that DSI group membership, even within seven days, would significantly predict risk of protracted recovery (i.e., beyond 21 days). Methods In this archival study, retrospective data were gathered from electronic medical records between September 2020 to March 2022. Records of participants between ages 12–18, those diagnosed with a sports-related concussion based on initial clinic visit diagnosis by a medical provider and those who established care within seven days of injury at a large pediatric specialty concussion clinic were examined. Participants were divided into three DSI groups (patients seen in < 48 h: “acute”, patients seen between 49 h < and < 96 h: “sub-acute”, and patients seen between 97 < and < 168 h: “post-acute”). A general linear model was constructed to examine relationships between relevant concussion factors (e.g., Post Concussion Scale Score, neurodevelopmental history, psychiatric history, concussion history, migraine history, overall VOMS change score, cognitive testing, sex, age, race, and ethnicity) that were either significant in the preliminary analysis or in clinical judgement and recovery time. Adjusted odds ratios (OR) were derived from a binary logistic regression model, in which recovery time was normal (≤ 21 recovery days) or protracted (> 21 recovery days). Results A total of 856 participants were eligible. Adolescents in the acute group (M = 15.12, SD = 8.04) had shorter recovery times in days compared to those in the sub-acute (M = 17.98, SD = 10.18) and post-acute (M = 21.12, SD = 10.12; F = 26.00, p < .001) groups. Further, participants in the acute (OR = 4.16) and sub-acute (OR = 1.37) groups who accessed specialty concussion clinics within 48 h were 4 times more likely to have a normal recovery and recovered approximately 6 days faster than the post-acute care group. Conclusions Earlier concussion care access predicted recovery times and was associated with lower risk for protracted recovery.

show abstract

“…On this basis, targeted exercise prescription has been shown to be an effective intervention to address symptom burden and functional deficits that commonly occur as a consequence of TBI (Alsalaheen et al, 2010;Archer et al, 2012;Baker et al, 2012;Ellis, Cordingley, et al, 2015;Ellis et al, 2016;Ellis, Leddy, et al, 2015;Fernandes et al, 2017;Gomez-Pinilla et al, 2008;Griesbach et al, 2004Griesbach et al, , 2009Leddy et al, 2007Leddy et al, , 2013Leddy et al, , 2016Storey et al, 2018). Some symptoms such as headache complaints, sleep disruption, and/or mood disorders, that can occur secondary to TBI, have been managed with prescription pharmaceuticals (although greater clarity regarding efficacy of these approaches is needed) (Bhatnagar et al, 2016;Liu et al, 2019;Meehan, 2011;Miller Phillips & Reddy, 2016;Plantier & Luauté, 2016). However, there is no intervention to proactively target the secondary injury phase of TBI in a manner that promotes earlier resolution of a range of symptom complaints and deficits observed clinically (Mohamadpour et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Nutritional interventions to improve neurophysiological impairments following traumatic brain injury: A systematic review

McGeown

Hume

Theadom

et al. 2020

J of Neuroscience Research

View full text Add to dashboard Cite

Traumatic brain injury (TBI) accounts for significant global health burden. Effects of TBI can become chronic even following mild injury. There is a need to develop effective therapies to attenuate the damaging effects of TBI and improve recovery outcomes. This literature review using a priori criteria (PROSPERO; CRD42018100623) summarized 43 studies between January 1998 and July 2019 that investigated nutritional interventions (NUT) delivered with the objective of altering neurophysiological (NP) outcomes following TBI. Risk of bias was assessed for included studies, and NP outcomes recorded. The systematic search resulted in 43 of 3,748 identified studies met inclusion criteria. No studies evaluated the effect of a NUT on NP outcomes of TBI in humans. Biomarkers of morphological changes and apoptosis, oxidative stress, and plasticity, neurogenesis, and neurotransmission were the most evaluated NP outcomes across the 43 studies that used 2,897 animals. The risk of bias was unclear in all reviewed studies due to poorly detailed methodology sections. Taking these limitations into account, anti-oxidants, branched chain amino acids, and ω-3 polyunsaturated fatty acids have shown the most promising pre-clinical results for altering NP outcomes following TBI. Refinement of pre-clinical methodologies used to evaluate effects of interventions on secondary damage of TBI would improve the likelihood of translation to clinical populations.

show abstract

Managing Patients with Prolonged Recovery Following Concussion

Cited by 9 publications

References 139 publications

The Course of Concussion Recovery in Children 6‐12 Years of Age: Experience From an Interdisciplinary Rehabilitation Clinic

The Course of Concussion Recovery in Children 6‐12 Years of Age: Experience From an Interdisciplinary Rehabilitation Clinic

Association between days for concussion recovery and initial specialty clinic evaluation within 48 hours

Nutritional interventions to improve neurophysiological impairments following traumatic brain injury: A systematic review

Contact Info

Product

Resources

About