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Corwin DJ, Myers SR, Arbogast KB, Lim MM, Elliott JE, Metzger KB, LeRoux P, Elkind J, Metheny H, Berg J, Pettijohn K, Master CL, Kirschen MP, Cohen AS. Head Injury Treatment With Healthy and Advanced Dietary Supplements: A Pilot Randomized Controlled Trial of the Tolerability, Safety, and Efficacy of Branched Chain Amino Acids in the Treatment of Concussion in Adolescents and Young Adults. J Neurotrauma 2024; 41:1299-1309. [PMID: 38468511 DOI: 10.1089/neu.2023.0433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
Concussion is a common injury in the adolescent and young adult populations. Although branched chain amino acid (BCAA) supplementation has shown improvements in neurocognitive and sleep function in pre-clinical animal models of mild-to-moderate traumatic brain injury (TBI), to date, no studies have been performed evaluating the efficacy of BCAAs in concussed adolescents and young adults. The goal of this pilot trial was to determine the efficacy, tolerability, and safety of varied doses of oral BCAA supplementation in a group of concussed adolescents and young adults. The study was conducted as a pilot, double-blind, randomized controlled trial of participants ages 11-34 presenting with concussion to outpatient clinics (sports medicine and primary care), urgent care, and emergency departments of a tertiary care pediatric children's hospital and an urban tertiary care adult hospital, between June 24, 2014 and December 5, 2020. Participants were randomized to one of five study arms (placebo and 15 g, 30 g, 45 g, and 54 g BCAA treatment daily) and followed for 21 days after enrollment. Outcome measures included daily computerized neurocognitive tests (processing speed, the a priori primary outcome; and attention, visual learning, and working memory), symptom score, physical and cognitive activity, sleep/wake alterations, treatment compliance, and adverse events. In total, 42 participants were randomized, 38 of whom provided analyzable data. We found no difference in our primary outcome of processing speed between the arms; however, there was a significant reduction in total symptom score (decrease of 4.4 points on a 0-54 scale for every 500 g of study drug consumed, p value for trend = 0.0036, [uncorrected]) and return to physical activity (increase of 0.503 points on a 0-5 scale for every 500 g of study drug consumed, p value for trend = 0.005 [uncorrected]). There were no serious adverse events. Eight of 38 participants reported a mild (not interfering with daily activity) or moderate (limitation of daily activity) adverse event; there were no differences in adverse events by arm, with only two reported mild adverse events (both gastrointestinal) in the highest (45 g and 54 g) BCAA arms. Although limited by slow enrollment, small sample size, and missing data, this study provides the first demonstration of efficacy, as well as safety and tolerability, of BCAAs in concussed adolescents and young adults; specifically, a dose-response effect in reducing concussion symptoms and a return to baseline physical activity in those treated with higher total doses of BCAAs. These findings provide important preliminary data to inform a larger trial of BCAA therapy to expedite concussion recovery.
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Affiliation(s)
- Daniel J Corwin
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sage R Myers
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kristy B Arbogast
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Miranda M Lim
- Oregon Alzheimer's Disease Research Center & Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
- Research Service and VA RR&D VISN20 Northwest Mental Illness Research Education and Clinical Center (MIRECC), VA Portland Health Care System, Portland, Oregon, USA
| | - Jonathan E Elliott
- Oregon Alzheimer's Disease Research Center & Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Kristina B Metzger
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Peter LeRoux
- Department of Neurosurgery, University of Rochester Medical Center and Bassett Medical Center, Cooperstown, New York, USA
| | - Jaclynn Elkind
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hannah Metheny
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeffrey Berg
- Department of Family Medicine, Suburban Community Hospital, East Norriton, Pennsylvania, USA
| | - Kevin Pettijohn
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Christina L Master
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Matthew P Kirschen
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Akiva S Cohen
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Chandran A, Boltz AJ, Brett BL, Walton SR, Robison HJ, Collins CL, Register-Mihalik JK, Mihalik JP. Patterns and predictors of concussion symptom presentations in NCAA athletes. Res Sports Med 2024; 32:316-330. [PMID: 35916338 DOI: 10.1080/15438627.2022.2105218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 10/16/2022]
Abstract
Sport-related concussion (SRC) is a complex injury, and SRCs are notably prevalent among National Collegiate Athletic Association (NCAA) athletes. We analysed SRCs and associated exposure data collected within the NCAA Injury Surveillance Program during 2014-2019. A total of 1,709 SRCs were reported with complete symptom profiles during the study period (Women's sports n = 499; Men's sports n = 1,210). Event type and academic class year most commonly predicted specific symptom presentations among athletes in men's sports, while symptom presentation among athletes in women's sports was most commonly predicted by class year and sport classification. We observed 78 and 69 significant pairwise symptom dependencies in men's and women's sports athletes, respectively; odds of longer symptom resolution time were higher with greater counts of symptoms with strongest cross-domain associations. Our findings highlight several contextual predictors of specific symptom presentations and identify parsimonious symptom subsets that may indicate protracted recovery among men's and women's sports athletes.
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Affiliation(s)
- Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
| | - Adrian J Boltz
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
| | - Benjamin L Brett
- Department of Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Samuel R Walton
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hannah J Robison
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
| | - Christy L Collins
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
| | - Johna K Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- STAR Heel Performance Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jason P Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Master CL, Corwin DJ, Fedonni D, Ampah SB, Housel KC, McDonald C, Arbogast KB, Grady MF. Dose-Response Effect of Mental Health Diagnoses on Concussion Recovery in Children and Adolescents. Sports Health 2024; 16:254-268. [PMID: 38349046 PMCID: PMC10916772 DOI: 10.1177/19417381241228870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Pre-existing mental health diagnoses may contribute to greater emotional symptom burden and prolonged recovery after concussion. HYPOTHESIS Youth with pre-existing mental health diagnoses will have greater emotional symptom burden, greater risk for delayed return to exercise, and more prolonged recovery from concussion than those without those diagnoses. STUDY DESIGN Prospective cohort. LEVEL OF EVIDENCE Level 3. METHODS A prospective registry of youth concussion was examined for differences in emotional symptom burden after injury to develop a predictive risk model for prolonged recovery. The impact of individual and total number of pre-existing mental health diagnoses (0, 1, 2, and 3+) was assessed, and multivariable logistic regression was performed to identify factors associated with prolonged recovery. RESULTS Among a cohort of 3105 youth with concussion, those with a history of mental health diagnoses, in a dose-response fashion, had greater postinjury emotional symptom burden (7 emotional symptoms vs 4; P < 0.01), visio-vestibular dysfunction (65% abnormal vs 56% abnormal; P < 0.01), later return to symptom-limited exercise (23 vs 21 days; P < 0.01), and overall longer concussion recovery (38 days, interquartile range [IQR] 18, 80) versus 25 days (IQR 13, 54; P < 0.01). Boys with prolonged recovery after concussion had greater emotional symptom burden than girls (5 emotional symptoms vs 3; P < 0.01). CONCLUSION Pre-existing mental health diagnoses are associated with greater postinjury emotional symptom burden and longer concussion recovery in a dose-response fashion. Visiovestibular deficits and delayed return to exercise are also associated with pre-existing mental health diagnoses and prolonged recovery. Boys with prolonged recovery from concussion experience greater emotional symptom burden than girls. CLINICAL RELEVANCE Addressing pre-existing mental health diagnoses is essential to concussion management. Boys with prolonged recovery from concussion may particularly benefit from interventions to address their higher emotional symptom burden. Interventions, including a home visio-vestibular exercise program and symptom-limited exercise, may contribute to improving time to concussion recovery.
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Affiliation(s)
- Christina L Master
- Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Daniel J Corwin
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Daniele Fedonni
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Steven B Ampah
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kaitlyn C Housel
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Catherine McDonald
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Kristy B Arbogast
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Matthew F Grady
- Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Rosenthal SL, Simpson TS, Kirkwood M, Peterson RL. Quality of Life in Youth Soccer Players After Mild Traumatic Brain Injury. J Athl Train 2024; 59:130-136. [PMID: 37459368 PMCID: PMC10895396 DOI: 10.4085/1062-6050-0011.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2024]
Abstract
CONTEXT Pediatric mild traumatic brain injuries (mTBIs) represent an evolving field of interest in youth athletics. Although most players recover within 4 weeks, some have symptoms that last longer. Little is known about youth health-related quality of life (HRQoL) after mTBI. OBJECTIVES To characterize youth HRQoL after soccer-related mTBI and to identify predictors of individual differences in HRQoL recovery. DESIGN Prospective cohort study. SETTING Youth soccer. PARTICIPANTS Soccer players, aged 8 to 17 years, who sustained an mTBI (n = 23) or orthopaedic injury (OI, n = 24) or remained uninjured (n = 23) during a single season. MAIN OUTCOME MEASURE(S) We assessed HRQoL via the Pediatric Quality of Life Inventory, version 4.0, and postconcussive symptoms via the Health and Behavior Index. Serial assessments occurred at 24 to 48 hours, 7 days, 30 days, and 90 days postinjury via telephone interview. RESULTS At 7 days postinjury, the mTBI and OI groups had poorer total HRQoL (F2,67 = 11.35, P < .001) than the uninjured control group. At 7 days, the mTBI group had the poorest psychosocial HRQoL, whereas the OI group had the poorest physical HRQoL. Differences between the mTBI and uninjured control groups resolved by 30 days. Within the mTBI group, players with significant postconcussive symptoms at 7 days had poorer total (F1,21 = 23.071, P ≤ .001; F1,21 = 5.798, P = .028), psychosocial (F1,21 = 16.488, P = < .001; F1,21 = 5.050, P = .039), and physical (F1,21 = 21.671, P = < .001; F1,21 = 5.119, P = .038) HRQoL at 7 and 30 days, respectively, than players with minimal symptoms; these differences resolved by 90 days. CONCLUSIONS As a group, youth soccer players who sustained mTBI had transient impairments in HRQoL that resolved by 30 days. A subset of players with significant postconcussive symptoms at 7 days postinjury had poorer HRQoL for at least 30 days postinjury than those whose postconcussive symptoms had resolved within a week of injury. This suggests ongoing recovery in this subset at 30 days and the potential utility of HRQoL as a measure of recovery.
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Affiliation(s)
| | - Tess S. Simpson
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora
| | - Michael Kirkwood
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora
| | - Robin L. Peterson
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora
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Sicard V, Ledoux AA, Tang K, Yeates KO, Brooks BL, Anderson P, Keightley M, Desire N, Beauchamp MH, Zemek R. The association between symptom burden and processing speed and executive functioning at 4 and 12 weeks following pediatric concussion. J Int Neuropsychol Soc 2024:1-13. [PMID: 38273645 DOI: 10.1017/s1355617724000043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
OBJECTIVES Symptoms and cognition are both utilized as indicators of recovery following pediatric concussion, yet their interrelationship is not well understood. This study aimed to investigate: 1) the association of post-concussion symptom burden and cognitive outcomes (processing speed and executive functioning [EF]) at 4 and 12 weeks after pediatric concussion, and 2) the moderating effect of sex on this association. METHODS This prospective, multicenter cohort study included participants aged 5.00-17.99 years with acute concussion presenting to four Emergency Departments of the Pediatric Emergency Research Canada network. Five processing speed and EF tasks and the Post-Concussion Symptom Inventory (PCSI; symptom burden, defined as the difference between post-injury and retrospective [pre-injury] scores) were administered at 4 and 12 weeks post-concussion. Generalized least squares models were conducted with task performances as dependent variables and PCSI and PCSI*sex interaction as the main predictors, with important pre-injury demographic and injury characteristics as covariates. RESULTS 311 children (65.0% males; median age = 11.92 [IQR = 9.14-14.21 years]) were included in the analysis. After adjusting for covariates, higher symptom burden was associated with lower Backward Digit Span (χ2 = 9.85, p = .043) and Verbal Fluency scores (χ2 = 10.48, p = .033) across time points; these associations were not moderated by sex, ps ≥ .20. Symptom burden was not associated with performance on the Coding, Continuous Performance Test, and Color-Word Interference scores, ps ≥ .17. CONCLUSIONS Higher symptom burden is associated with lower working memory and cognitive flexibility following pediatric concussion, yet these associations were not moderated by sex. Findings may inform concussion management by emphasizing the importance of multifaceted assessments of EF.
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Affiliation(s)
- Veronik Sicard
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Andrée-Anne Ledoux
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ken Tang
- Independent Statistical Consultant, Richmond, BC, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Brian L Brooks
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Peter Anderson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Mental Health Neuropsychology Program, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Michelle Keightley
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, TorontoON, Canada
- Departments of Occupational Science and Occupational Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Naddley Desire
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montreal, QC, Canada
- Ste-Justine Hospital Research Center, Montreal, QC, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
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Corwin DJ, Metzger KB, McDonald CC, Pfeiffer MR, Arbogast KB, Master CL. The Variability of Recovery From Pediatric Concussion Using Multimodal Clinical Definitions. Sports Health 2024; 16:79-88. [PMID: 36896665 PMCID: PMC10732108 DOI: 10.1177/19417381231152448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND While concussions are common pediatric injuries, a lack of agreement on a standard definition of recovery creates multiple challenges for clinicians and researchers alike. HYPOTHESIS The percentage of concussed youth deemed recovered as part of a prospective cohort study will differ depending on the recovery definition. STUDY DESIGN Descriptive epidemiologic study of a prospectively enrolled observational cohort. LEVEL OF EVIDENCE Level 3. METHODS Participants aged 11 to 18 years were enrolled from the concussion program of a tertiary care academic center. Data were collected from initial and follow-up clinical visits ≤12 weeks from injury. A total of 10 recovery definitions were assessed: (1) cleared to full return to sports; (2) return to full school; (3) self-reported return to normal; (4) self-reported full return to school; (5) self-reported full return to exercise; (6) symptom return to preinjury state; (7) complete symptom resolution; (8) symptoms below standardized threshold; (9) no abnormal visio-vestibular examination (VVE) elements; and (10) ≤1 abnormal VVE assessments. RESULTS In total, 174 participants were enrolled. By week 4, 63.8% met at least 1 recovery definition versus 78.2% by week 8 versus 88.5% by week 12. For individual measures of recovery at week 4, percent recovered ranged from 5% by self-reported full return to exercise to 45% for ≤1 VVE abnormality (similar trends at 8 and 12 weeks). CONCLUSION There is wide variability in the proportion of youth considered recovered at various points following concussion depending on the definition of recovery, with higher proportions using physiologic examination-based measures and lower proportions using patient-reported measures. CLINICAL RELEVANCE These results further emphasize the need for a multimodal assessment of recovery by clinicians as a single and standardized definition of recovery that captures the broad impact of concussion on a given patient continues to be elusive.
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Affiliation(s)
- Daniel J. Corwin
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kristina B. Metzger
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Catherine C. McDonald
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Melissa R. Pfeiffer
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kristy B. Arbogast
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christina L. Master
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Sports Medicine and Performance Center, and The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Recker R, Alshaikh E, Kaur A, Yeates KO, Yang J. Change in health-related quality of life and functional disability over time post-concussion in youth. Qual Life Res 2023; 32:3339-3347. [PMID: 37486548 DOI: 10.1007/s11136-023-03480-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE Concussions can have detrimental on children's cognitive, emotional, behavioral, and/or social functioning. We sought to examine changes in health-related quality of life (HRQOL) and functional disability from pre-injury to 1-week post-concussion, and to symptom resolution among youth ages 11-17 with a concussion. METHODS In this prospective, longitudinal cohort study, 83 concussed youth, ages 11-17, self-reported post-concussion symptoms daily as well as HRQOL and functional disability at baseline (pre-injury, retrospective), 1-week post-concussion, and symptom resolution. We modeled changes in overall and sub-scale HRQOL and functional disability scores over time from pre-injury to 1-week post-concussion and from 1-week post-concussion to symptom resolution using a piecewise linear mixed model, adjusting for potential covariables. Estimated fixed effects with a corresponding adjusted coefficient (beta), along with their 95% confidence intervals are presented. RESULTS Overall HRQOL worsened from pre-injury to 1-week post-injury (β = - 5.40, 95%CI - 9.22, - 1.58) but did not change from 1-week post-injury to symptom resolution. Physical HRQOL worsened from pre-injury to 1-week post-injury (β = - 9.90, 95%CI - 14.65, - 5.14) but improved from 1-week post-injury to symptom resolution (β = 1.64, 95%CI 0.50, 2.78), while psychosocial HRQOL showed no change over time. Functional disability worsened from pre-injury to 1-week post-injury (β = 8.36, 95%CI 5.93, 10.79) but with no change from 1-week post-injury to symptom resolution. Youth with symptom duration > 14 days reported worse HRQOL and functional disability than those who recovered in ≤ 14 days and greater daily post-concussion symptom scores were associated with worse HRQOL and functional disability. CONCLUSION Concussions have a negative impact on overall and physical HRQOL and functional disability in youth acutely post-injury. Ratings of HRQOL could be used to inform clinical treatment decisions to assist with the recovery process.
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Affiliation(s)
- Robyn Recker
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Enas Alshaikh
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Archana Kaur
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jingzhen Yang
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, 43205, USA.
- College of Medicine, The Ohio State University, Columbus, OH, 43210, USA.
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Scratch SE, Mallory KD, Al-Hakeem H, Lovell A, Moody K, Lam B, Brazill L, Knapp P, Hickling A. Move&Connect-Youth: A Virtual Group Intervention for Youth Experiencing Persisting Symptoms After Concussion. Dev Neurorehabil 2023; 26:471-482. [PMID: 38531782 DOI: 10.1080/17518423.2024.2331455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/12/2024] [Indexed: 03/28/2024]
Abstract
Move&Connect-Youth (M&C-Y) is an interdisciplinary virtual group intervention for youth experiencing persisting symptoms after concussion (PSAC) that includes psychoeducation, active rehabilitation, and goal-setting. Using an intervention mapping framework, this paper describes the iterative development of M&C-Y and findings from initial feasibility testing. Ten youth participated in M&C-Y completing pre-intervention demographic questionnaires and semi-structured exit interviews to understand participants' experience and gather feedback. M&C-Y was feasible based on apriori criteria and findings from interviews provided insights related to: (1) intervention structure, (2) intervention engagement, and (3) intervention takeaways. M&C-Y is a meaningful, feasible, and engaging intervention for youth with PSAC.
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Affiliation(s)
- Shannon E Scratch
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kylie D Mallory
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Hiba Al-Hakeem
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| | - Andrew Lovell
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Kim Moody
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Brendan Lam
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Lindsay Brazill
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Patricia Knapp
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Andrea Hickling
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Rivara FP, Ebel BE, Binjolkar M, Wang J, Hanron A, Kroshus E, Boyle LN, Patrick KE. Cognitive Impairment and Driving Skills in Youth After Concussion. J Neurotrauma 2023; 40:1187-1196. [PMID: 36416238 PMCID: PMC10259608 DOI: 10.1089/neu.2022.0308] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Abstract Concussions can impact cognitive processes necessary for driving. Young adults, a group who are more likely to engage in risky behaviors, have limited driving experience and a higher rate of motor vehicle collisions; they may be at higher risk for driving impairment after concussion. There are no clear guidelines for return-to-driving following a concussion. We sought to examine the simulated driving performance of young drivers after receiving medical care following a concussion, compared with a similar control population, to examine the association of driving performance with performance on neuropsychological tests. We evaluated 47 drivers, 16- to 25-year-old, within 3 weeks of sustaining a concussion and 50 drivers with similar characteristics who had not sustained concussions. Participants completed demographic questionnaires, the Sport Concussion Assessment Tool-5 (SCAT-5), and a brief set of neurocognitive tests, including the National Institutes of Health (NIH) Toolbox Cognition Battery and the Trail Making Test, and a simulated driving assessment. At various times during simulated driving, participants were asked to respond to tactile stimuli using the tactile detection response task (TDRT), a validated method of testing cognitive load during simulated driving. The concussion group reported significantly higher symptoms on the SCAT-5 than the comparison group. Performance on crystallized neurocognitive skills was similar between groups. Performance on fluid neurocognitive skills was significantly lower in the concussion than comparison group, although scores were in the normal range for both groups. Simulated driving was similar between groups, although there was a small but significant difference in variation in speed as well as TDRT miss rate, with worse performance by the concussion group. Symptom report on the SCAT-5 was significantly associated with TDRT miss rate. In addition, neurocognitive test scores significantly predicted TDRT reaction time and miss count with medium to large effect sizes. Results suggest that neurocognitive screening may be a useful tool for predicting capacity to return to drive. However, further research is needed to determine guidelines for how neuropsychological tests can be used to make return to driving recommendations and to evaluate effects of concussion on real world driving.
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Affiliation(s)
- Frederick P. Rivara
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Beth E. Ebel
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Mayuree Binjolkar
- Department of Civil and Environmental Engineering, University of Washington, Seattle, Washington, USA
| | - Jin Wang
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Amelia Hanron
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Emily Kroshus
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Linda Ng Boyle
- Department of Industrial and Systems Engineering, University of Washington, Seattle, Washington, USA
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The Association of Sport Specialization and Concussion History on Self-Reported Depressive Symptoms and Quality of Life Among High School Athletes. Clin J Sport Med 2023; 33:139-144. [PMID: 36730678 DOI: 10.1097/jsm.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/23/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess the association of sport specialization combined with sport-related concussion (SRC) history on depression and health-related quality of life (HRQoL) in a population of high school athletes. DESIGN Cross-sectional study. SETTING High schools. PARTICIPANTS Two thousand four hundred fifty-three athletes through the State of Wisconsin. INDEPENDENT VARIABLES Sport specialization and SRC history. MAIN OUTCOME MEASURES Athletes completed questionnaires reporting their SRC history, sports participation (single-sport or multisport), Patient Health Questionnaire-9 (PHQ-9), and Pediatric Quality of Life 4.0 (PedsQL). We used multivariate binary logistic regression to assess the odds ratio (OR) for depressive symptoms based on SRC and sport participation history. Separate multilinear regression evaluated the association between the PedsQL, SRC, and sport participation history. The interaction of sport specialization and SRC history was explored in both regression models. RESULTS High school athletes who participated in single-sport activities had a greater odds of reporting higher severity of depressive symptoms on PHQ-9 scores (OR, 1.50; 95% CI, 1.11-2.02) and reduced PedsQL ( P < 0.001) compared with their multisport counterparts. There were no associations between SRC history and either PHQ-9 or PedsQL scores. Statistically significant interactions between sport specialization and SRC were not found among all models. CONCLUSION Single-sport high school athletes reported a reduction in HRQoL measures along with higher depressive symptoms when compared with the multisport athletes. The SRC history did not have a lingering effect on depression or HRQoL in this study. These findings raise some interesting concerns regarding the quality of mental health in adolescent athletes solely focused on single-sport endeavors.
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11
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Shore J, Bernick A, Nalder E, Hutchison M, Reed N, Hunt A. Adolescent and parent experiences with Tele-Active Rehabilitation for concussion: an exploratory qualitative study. Brain Inj 2022; 36:1140-1148. [PMID: 35993317 DOI: 10.1080/02699052.2022.2114610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PURPOSE To explore the experiences of adolescents with concussion and their parents who participated in a novel remotely delivered Tele-Active Rehabilitation (Tele-AR) intervention involving sub-symptom threshold exercise, education, and support. Specifically, we aimed to elicit perspectives regarding the remote delivery approach, valued aspects of the program, and perceived benefits of the intervention. METHODS This qualitative study took place within the context of a larger mixed-methods project exploring the feasibility of the Tele-AR intervention. A descriptive qualitative design was utilized. Semi-structured interviews were conducted with adolescents (n = 3; ages 14-17 years) with concussion and one of their parents (n = 3) within one week of completing the six-week Tele-AR intervention. Data were analyzed using thematic analysis. RESULTS Four themes were identified that capture participant experiences in the intervention: (1) Enabling access to active rehabilitation; (2) Focusing on individual needs; (3) Learning to take responsibility for recovery; and (4) Convenience and comfort of engaging in rehabilitation from home. CONCLUSIONS A small sample of 3 adolescents with concussion and their parents were satisfied with the Tele-AR intervention and appreciated the convenience and comfort of engaging in rehabilitation from home, which facilitated adolescents taking responsibility for their own recovery. Findings support continued study of Tele-AR, which may be an accessible intervention to facilitate recovery in adolescents with concussion.
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Affiliation(s)
- Josh Shore
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Alana Bernick
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Emily Nalder
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Michael Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada.,Neuroscience Research Program, Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nick Reed
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Anne Hunt
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
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12
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Callahan C, Bloom J, Fonseca J, Ramsey K, DeMaio V, Deichmeister M, Register-Mihalik J. Presence of persistent parent reported emotional and behavioral-related concussion symptoms is associated with lower health-related quality of life in adolescent athletes. J Neurotrauma 2022; 39:1214-1221. [PMID: 35481782 DOI: 10.1089/neu.2021.0398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Persistent concussion symptoms in adolescents are associated with lower health-related quality of life (HRQOL). However, the association between persistent emotional and behavioral-related concussion symptoms (EBS) and HRQOL is unknown. This study was a prospective cohort of adolescent athletes presenting to a concussion clinic within three days post-concussion and completing a one-month follow up. The independent variable in these analyses was parent reported EBS symptom presence grouped as: 1) no EBS; 2) EBS present at pre-concussion levels; and 3) EBS worse than pre-concussion. EBS included the following concussion symptoms: feeling irritable, depressed, frustrated/impatient, restless, reduced tolerance to stress/emotion, poor concentration, and fear of permanent symptoms. Dependent variables were parent reported psychosocial, physical, and total HRQOL. Separate multivariable linear regression models controlling for age, sex, and concussion history were used to assess the association between EBS and HRQOL. Estimated adjusted mean differences (MD) and 95% confidence intervals (CI) were used to assess associations; MDs with a 95%CI excluding 0.0 were considered statistically significant. Overall, n=245 presented to the study clinic three days post-concussion and completed the one-month follow-up (Mage=14.28±2.09 years, 59.02% male, 90.64% Caucasian, 31.84% with concussion history). At one-month post-concussion, adolescents with pre-concussion EBS levels had significantly lower psychosocial, physical, and total HRQOL than those with no EBS. Additionally, those with EBS worse than pre-concussion had significantly lower psychosocial, physical, and total HRQOL than those with no EBS and EBS at pre-concussion levels. These findings highlight the importance of HRQOL assessments and that targeted interventions may be needed for those with EBS at one-month post-concussion to improve HRQOL.
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Affiliation(s)
- Christine Callahan
- The University of North Carolina at Chapel Hill, 2331, Exercise and Sports Science, 2207 Stallings-Evans Sports Medicine Complex Campus Box 8700, Chapel Hill, North Carolina, United States, 27599;
| | - Josh Bloom
- Carolina Family Practice & Sports Medicine, Cary, North Carolina, United States;
| | - Janna Fonseca
- Carolina Family Practice & Sports Medicine, Cary, North Carolina, United States;
| | - Kristen Ramsey
- Carolina Family Practice & Sports Medicine, Cary, North Carolina, United States;
| | - Valerie DeMaio
- The University of North Carolina at Chapel Hill, 2331, Department of Emergency Medicine, Chapel Hill, North Carolina, United States;
| | - Margaret Deichmeister
- University of North Carolina at Chapel Hill School of Medicine, 6797, Chapel Hill, North Carolina, United States;
| | - Johna Register-Mihalik
- University of North Carolina at Chapel Hill, 2331, Department of Exercise and Sport Science, Chapel Hill, North Carolina, United States, 27515;
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13
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Shore J, Nalder E, Hutchison M, Reed N, Hunt A. Tele-Active Rehabilitation for Youth With Concussion: Evidence-Based and Theory-Informed Intervention Development. JMIR Pediatr Parent 2022; 5:e34822. [PMID: 35377326 PMCID: PMC9016504 DOI: 10.2196/34822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Active rehabilitation involving subsymptom threshold exercise combined with education and support promotes recovery in youth with concussion but is typically delivered in person, which may limit accessibility for families because of a lack of services in their communities or logistical challenges to attending in-person sessions. OBJECTIVE This paper describes the evidence-based and theory-informed development of the Tele-Active Rehabilitation (Tele-AR) intervention for pediatric concussion, which was specifically designed for remote service delivery. METHODS The intervention was designed by clinician-researchers with experience in pediatric concussion rehabilitation following the Medical Research Council guidance for developing complex interventions. Development involved a critical review of the literature to identify existing evidence, the expansion of the theoretical basis for active rehabilitation, and the modeling of the intervention process and outcomes. RESULTS Tele-AR is a 6-week home exercise and education and support program facilitated through weekly videoconferencing appointments with a clinician. Exercise consists of low- to moderate-intensity subsymptom threshold aerobic activity and coordination drills that are individualized to participant needs and interests (prescribed for 3 days per week). Education includes the evidence-supported Concussion & You self-management program, which covers topics related to energy management, nutrition, hydration, sleep hygiene, and return to activity. Elements of self-determination theory are incorporated to support motivation and engagement. We present a logic model describing predicted intervention effects using a biopsychosocial conceptualization of outcomes after concussion. CONCLUSIONS The Tele-AR intervention may help to increase access to care that improves recovery and promotes a timely return to activity in youth with concussion. Future research is needed to evaluate the feasibility and efficacy of this approach.
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Affiliation(s)
- Josh Shore
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Emily Nalder
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Michael Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Nick Reed
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Anne Hunt
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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14
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Shore J, Hutchison MG, Nalder E, Reed N, Hunt A. Tele-Active Rehabilitation for adolescents with concussion: a feasibility study. BMJ Open Sport Exerc Med 2022; 8:e001277. [PMID: 35309373 PMCID: PMC8886419 DOI: 10.1136/bmjsem-2021-001277] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Active rehabilitation involving subsymptom threshold exercise and education/support promotes recovery among adolescents with concussion, but is typically delivered in-person, which limits accessibility. This study explored the feasibility of a remotely delivered Tele-Active Rehabilitation (Tele-AR) intervention for adolescents with concussion. Methods A precase–postcase series design was used. Three adolescents (ages 14–17 years) experiencing postconcussion symptoms ≥2 weeks postinjury participated with a parent. The Tele-AR intervention was a 6-week programme supervised by a rehabilitation clinician through weekly videoconferencing appointments and included (1) aerobic exercise, (2) coordination drills and (3) comprehensive education and support. Feasibility indicators included rates of recruitment, retention, adherence, as well as adolescent and parent ratings of technology usability using an adapted Telehealth Usability Questionnaire and satisfaction using the Client Satisfaction Questionnaire-8. Prechanges to postchanges in postconcussion symptoms, illness perceptions, and occupational performance and satisfaction were also assessed. Results Rates of recruitment (n=3/4) and retention (n=3/3) achieved success criteria. Adherence was high among all participants (77%–100%), and there were no adverse events. Participant ratings of technology usability and satisfaction approached 90%. All participants reported improvements in postconcussion symptoms and illness perception. Clinically significant positive changes were also observed in occupational performance and satisfaction. Conclusions The Tele-AR intervention appears feasible in a small group of adolescents with concussion, and positive changes were observed in postconcussion symptoms, illness perception and occupational performance. Further study is warranted to evaluate the efficacy of this approach, which may enable access to care that supports recovery in adolescents with concussion.
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Affiliation(s)
- Josh Shore
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Michael G Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Emily Nalder
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Nick Reed
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Anne Hunt
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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15
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Sharma HS, Muresanu DF, Sahib S, Tian ZR, Lafuente JV, Buzoianu AD, Castellani RJ, Nozari A, Li C, Zhang Z, Wiklund L, Sharma A. Cerebrolysin restores balance between excitatory and inhibitory amino acids in brain following concussive head injury. Superior neuroprotective effects of TiO 2 nanowired drug delivery. PROGRESS IN BRAIN RESEARCH 2021; 266:211-267. [PMID: 34689860 DOI: 10.1016/bs.pbr.2021.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Concussive head injury (CHI) often associated with military personnel, soccer players and related sports personnel leads to serious clinical situation causing lifetime disabilities. About 3-4k head injury per 100k populations are recorded in the United States since 2000-2014. The annual incidence of concussion has now reached to 1.2% of population in recent years. Thus, CHI inflicts a huge financial burden on the society for rehabilitation. Thus, new efforts are needed to explore novel therapeutic strategies to treat CHI cases to enhance quality of life of the victims. CHI is well known to alter endogenous balance of excitatory and inhibitory amino acid neurotransmitters in the central nervous system (CNS) leading to brain pathology. Thus, a possibility exists that restoring the balance of amino acids in the CNS following CHI using therapeutic measures may benefit the victims in improving their quality of life. In this investigation, we used a multimodal drug Cerebrolysin (Ever NeuroPharma, Austria) that is a well-balanced composition of several neurotrophic factors and active peptide fragments in exploring its effects on CHI induced alterations in key excitatory (Glutamate, Aspartate) and inhibitory (GABA, Glycine) amino acids in the CNS in relation brain pathology in dose and time-dependent manner. CHI was produced in anesthetized rats by dropping a weight of 114.6g over the right exposed parietal skull from a distance of 20cm height (0.224N impact) and blood-brain barrier (BBB), brain edema, neuronal injuries and behavioral dysfunctions were measured 8, 24, 48 and 72h after injury. Cerebrolysin (CBL) was administered (2.5, 5 or 10mL/kg, i.v.) after 4-72h following injury. Our observations show that repeated CBL induced a dose-dependent neuroprotection in CHI (5-10mL/kg) and also improved behavioral functions. Interestingly when CBL is delivered through TiO2 nanowires superior neuroprotective effects were observed in CHI even at a lower doses (2.5-5mL/kg). These observations are the first to demonstrate that CBL is effectively capable to attenuate CHI induced brain pathology and behavioral disturbances in a dose dependent manner, not reported earlier.
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Affiliation(s)
- Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
| | - Dafin F Muresanu
- Department of Clinical Neurosciences, University of Medicine & Pharmacy, Cluj-Napoca, Romania; "RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Seaab Sahib
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, United States
| | - Z Ryan Tian
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, United States
| | - José Vicente Lafuente
- LaNCE, Department of Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Anca D Buzoianu
- Department of Clinical Pharmacology and Toxicology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Rudy J Castellani
- Department of Pathology, University of Maryland, Baltimore, MD, United States
| | - Ala Nozari
- Anesthesiology & Intensive Care, Massachusetts General Hospital, Boston, MA, United States
| | - Cong Li
- Department of Neurosurgery, Chinese Medicine Hospital of Guangdong Province; The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Yuexiu District, Guangzhou, China
| | - Zhiquiang Zhang
- Department of Neurosurgery, Chinese Medicine Hospital of Guangdong Province; The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Yuexiu District, Guangzhou, China
| | - Lars Wiklund
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
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16
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Evaluating the feasibility and efficacy of the Amsterdam memory and attention training for children (Amat-c) following acquired brain injury (ABI): protocol for a pilot study with online clinician support. BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2021.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Background:
Attention and memory deficits are common following paediatric acquired brain injury (ABI). However, there are few evidence-based interventions to improve these domains and benefit the everyday life of children post-injury. The Amsterdam Memory and Attention Training for children (Amat-c) has been translated from Dutch to English and shown to improve attention and memory skills in children following ABI. This protocol describes a study to expand accessibility of the program by using online, clinician-supported delivery with children post-ABI.
Method/design:
The study is a randomized controlled trial. Participants will be 40 children aged 8–16 a minimum of one-year post-ABI. Participants in the treatment group will complete 18 weekly sessions of the Amat-c program with weekly online clinician support. Participants in the active-control group will be administered ABI psychoeducation via a booklet for parents, with weekly online clinician contact. Attention and memory will be assessed at three time points up to six months post-intervention.
Results:
Analysis will be repeated measures multivariate planned comparisons; using the Statistical Package for the Social Sciences (IBM SPSS Statistics) General Linear Model procedure will compare pre- and post-intervention and six-month follow-up outcomes.
Discussion:
If shown efficacious in improving attention and memory, our team will then take a key role in implementing Amat-c into clinical care.
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Riemann L, Voormolen DC, Rauen K, Zweckberger K, Unterberg A, Younsi A. Persistent postconcussive symptoms in children and adolescents with mild traumatic brain injury receiving initial head computed tomography. J Neurosurg Pediatr 2021; 27:538-547. [PMID: 33636701 DOI: 10.3171/2020.9.peds20421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/08/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this paper was to evaluate the prevalence of postconcussive symptoms and their relation to health-related quality of life (HRQOL) in pediatric and adolescent patients with mild traumatic brain injury (mTBI) who received head CT imaging during initial assessment. METHODS Patients aged between 5 and 21 years with mTBI (Glasgow Coma Scale scores 13-15) and available Rivermead Post Concussion Questionnaire (RPQ) at 6 months of follow-up in the multicenter, prospectively collected CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI) study were included. The prevalence of postconcussive symptoms was assessed, and the occurrence of postconcussive syndrome (PSC) based on the ICD-10 criteria, was analyzed. HRQOL was compared in patients with and without PCS using the Quality of Life after Brain Injury (QOLIBRI) questionnaire. RESULTS A total of 196 adolescent or pediatric mTBI patients requiring head CT imaging were included. High-energy trauma was prevalent in more than half of cases (54%), abnormalities on head CT scans were detected in 41%, and admission to the regular ward or intensive care unit was necessary in 78%. Six months postinjury, 36% of included patients had experienced at least one moderate or severe symptom on the RPQ. PCS was present in 13% of adolescents and children when considering symptoms of at least moderate severity, and those patients had significantly lower QOLIBRI total scores, indicating lower HRQOL, compared with young patients without PCS (57 vs 83 points, p < 0.001). CONCLUSIONS Adolescent and pediatric mTBI patients requiring head CT imaging show signs of increased trauma severity. Postconcussive symptoms are present in up to one-third of those patients, and PCS can be diagnosed in 13% 6 months after injury. Moreover, PCS is significantly associated with decreased HRQOL.
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Affiliation(s)
- Lennart Riemann
- 1Department of Neurosurgery, University Hospital Heidelberg, Germany
| | - Daphne C Voormolen
- 2Department of Public Health, Erasmus MC-University Medical Center Rotterdam, The Netherlands; and
| | - Katrin Rauen
- 3University Hospital of Psychiatry Zurich, Department of Geriatric Psychiatry and Institute for Regenerative Medicine, University of Zurich, Switzerland
| | - Klaus Zweckberger
- 1Department of Neurosurgery, University Hospital Heidelberg, Germany
| | - Andreas Unterberg
- 1Department of Neurosurgery, University Hospital Heidelberg, Germany
| | - Alexander Younsi
- 1Department of Neurosurgery, University Hospital Heidelberg, Germany
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Patsimas T, Howell DR, Potter MN, Provance AJ, Kirkwood MW, Wilson JC. Concussion-Symptom Rating Correlation Between Pediatric Patients and Their Parents. J Athl Train 2021; 55:1020-1026. [PMID: 32031884 DOI: 10.4085/1062-6050-200-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
CONTEXT Understanding how parents and their children perceive concussion symptoms may provide insights into optimal concussion-management strategies. OBJECTIVE To examine patient-parent correlations and agreement on concussion-symptom ratings, to identify differences in patient-parent symptom reporting between children (8-12 years of age) and adolescents (13-18 years of age), and to evaluate the correlation between patient and parent initial symptom-severity ratings with symptom duration and return-to-play time. DESIGN Cross-sectional study. SETTING Primary care sports medicine clinic. PATIENTS OR OTHER PARTICIPANTS A total of 267 patients aged 8 to 18 years seen for care within 21 days of sustaining a concussion. Patients were classified as children (n = 65; age = 11.3 ± 1.4 years; age range, 8-12 years) or adolescents (n = 202; age = 15.5 ± 1.4 years; age range, 13-18 years). MAIN OUTCOME MEASURE(S) Each patient and his or her parent (or legal guardian) completed a concussion-symptom-frequency inventory, the Health and Behavior Inventory (HBI), at the initial postinjury examination. Patients were followed until they no longer reported concussion symptoms (symptom-resolution time) and were allowed to return to unrestricted sport participation (return-to-play time). RESULTS At the initial examination (8.9 ± 5.2 days postinjury), the symptom-frequency correlation between children and their parents was high (rs = 0.88; 95% confidence interval [CI] = 0.80, 0.95). Adolescents' symptom-frequency reports were also highly correlated with those of their parents (rs = 0.78; 95% CI = 0.71, 0.85). However, the child-parent correlation was higher than the adolescent-parent agreement (z = 2.21, P = .03). Greater patient (consolidated child and adolescent) HBI ratings were associated with longer symptom-resolution times (coefficient = 0.019; 95% CI = 0.007, 0.031; P = .002) and longer return-to-play times (coefficient = 0.012; 95% CI = 0.002, 0.022; P = .02), whereas parent HBI ratings were not. CONCLUSIONS Our findings may help to set expectations regarding concussion-symptom durations and return-to-play timing for pediatric patients and their families. Given the patient-parent correlations in our sample, substantial reporting discrepancies between patients and their parents may be a relevant factor for clinicians to investigate further during concussion evaluations.
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Affiliation(s)
- Tatiana Patsimas
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - David R Howell
- Department of Orthopedics, University of Colorado School of Medicine, Aurora.,Sports Medicine Center, Children's Hospital Colorado, Aurora
| | - Morgan N Potter
- Sports Medicine Center, Children's Hospital Colorado, Aurora
| | - Aaron J Provance
- Department of Orthopedics, University of Colorado School of Medicine, Aurora.,Sports Medicine Center, Children's Hospital Colorado, Aurora
| | - Michael W Kirkwood
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora.,Rehabilitation Medicine, Children's Hospital Colorado, Aurora
| | - Julie C Wilson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora.,Department of Orthopedics, University of Colorado School of Medicine, Aurora.,Sports Medicine Center, Children's Hospital Colorado, Aurora
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19
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Johnson AM, McCarty CA, Marcynyszyn LA, Zatzick DF, Chrisman SP, Rivara FP. Child- compared with parent-report ratings on psychosocial measures following a mild traumatic brain injury among youth with persistent post-concussion symptoms. Brain Inj 2021; 35:574-586. [PMID: 33733955 DOI: 10.1080/02699052.2021.1889663] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Primary Objective: To compare child- and parent-report ratings on the Health Behavior Inventory, Revised Child Anxiety and Depression Scale-Short Version (anxiety subscale), Patient Health Questionnaire-9, and Pediatric Quality of Life InventoryTM among children with persistent post-concussive symptoms following a sports- or recreation-related concussion, overall and by child age and gender.Research Design: Cross-sectional study examining baseline data from a randomized, comparative effectiveness trial.Methods and Procedures: Inter-rater reliability was assessed using two-way random effects model (absolute agreement) intraclass correlations, correlations were examined using Spearman's rho, mean differences were determined using paired t-tests, and agreement was examined using Bland-Altman plots.Main Outcomes and Results: The final analytic sample was 200 parent-child dyads [child Mage = 14.7 (95% CI: 14.5, 15.0)]. Reliability and correlations were modest overall. When considering child age and gender, reliability ranged from poor to excellent (-1.01-0.95) and correlations ranged from weak to strong (-0.64-0.94). Overall, children reported more symptoms but better functioning than parents, and mean differences in scores were greater among females (versus males) and ages 16-18 (versus younger groups).Conclusions: Findings should inform the use and interpretation of psychosocial measures when developing appropriate youth concussion treatment plans.
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Affiliation(s)
- Ashleigh M Johnson
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, US
| | - Carolyn A McCarty
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, US.,Department of Pediatrics, University of Washington, Seattle, US
| | - Lyscha A Marcynyszyn
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, US
| | - Douglas F Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, US.,Harborview Injury Prevention and Research Center, University of Washington, Seattle, USA
| | - Sara Pd Chrisman
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, US.,Department of Pediatrics, University of Washington, Seattle, US
| | - Frederick P Rivara
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, US.,Department of Pediatrics, University of Washington, Seattle, US.,Harborview Injury Prevention and Research Center, University of Washington, Seattle, USA
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20
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D'Silva L, Devos H, Hunt SL, Chen J, Smith D, Rippee MA. Concussion symptoms experienced during driving may influence driving habits. Brain Inj 2020; 35:59-64. [PMID: 33297775 DOI: 10.1080/02699052.2020.1857839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: To examine the symptoms experienced and the change in driving habits in individuals with concussion.Materials and methods: A survey was created by a team of rehabilitation professionals who see persons with concussion in their clinics. The survey captured demographics, mechanism of injury, date of injury, symptoms experienced during driving, if drivers felt safe when driving, and changes in driving habits since the concussion. Non-parametric tests were used to compare symptoms experienced and driving habits across three groups which were created based on time since injury.Results: Of the 140 participants, 74% (104/140) had resumed driving after concussion; of these 27% (28/104) reported that they felt unsafe while driving. Forty-four per cent (46/104) experienced symptoms while driving, of which headache, and difficulty concentrating were the most common symptoms experienced throughout the concussion spectrum (acute to chronic phase). Most drivers (78/104, 75%) with concussion had changed their driving habits by driving less often and shorter distances, and by avoiding nighttime driving and heavy traffic areas.Conclusions: Headache and concentration problems were experienced by drivers regardless of the time since injury. Most drivers had made changes to their driving habits. Clinicians should consider the symptom burden patients experience and discuss driving restrictions to ensure driving safety.
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Affiliation(s)
- L D'Silva
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas, USA
| | - H Devos
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas, USA
| | - S L Hunt
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas, USA
| | - J Chen
- Center for Concussion Management, University of Kansas Health System, Kansas City, Kansas, USA
| | - D Smith
- Center for Concussion Management, University of Kansas Health System, Kansas City, Kansas, USA
| | - M A Rippee
- Center for Concussion Management, University of Kansas Health System, Kansas City, Kansas, USA
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21
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Rosenbaum PE, Locandro C, Chrisman SPD, Choe MC, Richards R, Pacchia C, Cook LJ, Rivara FP, Gioia GA, Giza CC. Characteristics of Pediatric Mild Traumatic Brain Injury and Recovery in a Concussion Clinic Population. JAMA Netw Open 2020; 3:e2021463. [PMID: 33196804 PMCID: PMC7670312 DOI: 10.1001/jamanetworkopen.2020.21463] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Pediatric mild traumatic brain injury (TBI) and concussion are a public health challenge with up to 30% of patients experiencing prolonged recovery. Pediatric patients presenting to concussion clinics often have ongoing impairments and may be at increased risk for persistent symptoms. Understanding this population is critical for improved prognostic estimates and optimal treatment. OBJECTIVE To describe pediatric patients presenting to concussion clinics and characterize factors associated with their recovery. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included patients enrolled at multicenter concussion specialty clinics from the Four Corners Youth Consortium from December 2017 to July 2019, with up to 12-month follow-up. Patients were eligible if they were aged 5 to 18.99 years with a diagnosis of mild TBI or concussion presenting to participating clinics within 8 weeks of injury. Patients were excluded if the patient or their parents were unable to read or sign the consent document, or if the patient had a Glasgow Coma Scale score less than 13 or a penetrating injury. Data were analyzed from February 2019 to April 2020. EXPOSURES Diagnosis of mild TBI or concussion. MAIN OUTCOMES AND MEASURES This study used National Institute of Neurological Disorders and Stroke common data elements, including data on demographic characteristics, injury details, history, neurological and neuropsychological assessments, and treatment. RESULTS A total of 600 patients were consecutively enrolled, among whom 324 (54.0%) were female and 435 (72.5%) were adolescents (ie, aged 13-18 years). A higher proportion of girls and women (248 patients [76.5%]) were adolescents compared with boys and men (187 patients [67.8%]) (P = .02), and girls and women reported significantly more preexisting anxiety compared with boys and men (80 patients [26.7%] vs 46 patients [18.7%]; P = .03). Significantly more adolescents reported preexisting migraines compared with preadolescents (82 patients [20.9%] vs 15 patients [10.9%]; P = .01). Girls and women recovered more slowly than boys and men (persistent symptoms after injury: week 4, 217 patients [81.6%] vs 156 patients [71.2%]; week 8, 146 patients [58.9%] vs 89 patients [44.3%]; week 12, 103 patients [42.6%] vs 58 patients [30.2%]; P = .01). Patients with history of migraine or anxiety or depression recovered more slowly than those without, regardless of sex. CONCLUSIONS AND RELEVANCE These findings suggest that identification of subgroups of pediatric patients with mild TBI or concussion at risk for prolonged recovery could aid in better prognostic estimates and more targeted treatment interventions.
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Affiliation(s)
- Philip E. Rosenbaum
- David Geffen School of Medicine, Department of Neurosurgery, University of California, Los Angeles
- Steve Tisch BrainSPORT Program, University of California, Los Angeles
| | | | - Sara P. D. Chrisman
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle
- Harborview Injury Prevention and Research Center, Seattle, Washington
| | - Meeryo C. Choe
- Steve Tisch BrainSPORT Program, University of California, Los Angeles
- David Geffen School of Medicine, Department of Pediatrics, UCLA Mattel Children’s Hospital, Los Angeles, California
| | | | | | | | - Frederick P. Rivara
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle
- Harborview Injury Prevention and Research Center, Seattle, Washington
| | - Gerard A. Gioia
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine, Washington, District of Columbia
- Children’s National Hospital, Rockville, Maryland
| | - Christopher C. Giza
- David Geffen School of Medicine, Department of Neurosurgery, University of California, Los Angeles
- Steve Tisch BrainSPORT Program, University of California, Los Angeles
- David Geffen School of Medicine, Department of Pediatrics, UCLA Mattel Children’s Hospital, Los Angeles, California
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22
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Fong AK, Allen MD, Waltzman D, Sarmiento K, Yeates KO, Suskauer S, Wintermark M, Lindberg DM, Tate DF, Wilde EA, Loewen JL. Neuroimaging in Pediatric Patients with Mild Traumatic Brain Injury: Relating the Current 2018 Centers for Disease Control Guideline and the Potential of Advanced Neuroimaging Modalities for Research and Clinical Biomarker Development. J Neurotrauma 2020; 38:44-52. [PMID: 32640874 DOI: 10.1089/neu.2020.7100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Center for Disease Control and Prevention (CDC)'s 2018 Guideline for current practices in pediatric mild traumatic brain injury (mTBI; also referred to as concussion herein) systematically identified the best up-to-date practices based on current evidence and, specifically, identified recommended practices regarding computed tomography (CT), magnetic resonance imaging (MRI), and skull radiograph imaging. In this article, we discuss types of neuroimaging not discussed in the guideline in terms of their safety for pediatric populations, their potential application, and the research investigating the future use of certain modalities to aid in the diagnosis and treatment of mTBI in children. The role of neuroimaging in pediatric mTBI cases should be considered for the potential contribution to children's neural and social development, in addition to the immediate clinical value (as in the case of acute structural findings). Selective use of specific neuroimaging modalities in research has already been shown to detect aspects of diffuse brain injury, disrupted cerebral blood flow, and correlate physiological factors with persistent symptoms, such as fatigue, cognitive decline, headache, and mood changes, following mTBI. However, these advanced neuroimaging modalities are currently limited to the research arena, and any future clinical application of advanced imaging modalities in pediatric mTBI will require robust evidence for each modality's ability to provide measurement of the subtle conditions of brain development, disease, damage, or degeneration, while accounting for variables at both non-injury and time-post-injury epochs. Continued collaboration and communication between researchers and healthcare providers is essential to investigate, develop, and validate the potential of advanced imaging modalities in pediatric mTBI diagnostics and management.
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Affiliation(s)
| | | | - Dana Waltzman
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia, USA
| | - Kelly Sarmiento
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia, USA
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | | | - Max Wintermark
- Department of Neuroradiology, Stanford University, Stanford, California, USA
| | - Daniel M Lindberg
- Emergency Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - David F Tate
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, Missouri, USA
| | - Elizabeth A Wilde
- Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
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23
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Hunt AW, Agnihotri S, Sack L, Tint A, Greenspoon D, Gauvin-Lepage J, Gagnon I, Reed N, Scratch S. Mood-related changes in children and adolescents with persistent concussion symptoms following a six-week active rehabilitation program. Brain Inj 2020; 34:1068-1073. [PMID: 32529851 DOI: 10.1080/02699052.2020.1776396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PRIMARY OBJECTIVE The purpose of this study is to explore changes in mood in youth with persistent post-concussion symptoms following participation in a six-week active rehabilitation program. RESEARCH DESIGN A pre-post test design was used. METHODS AND PROCEDURES Participants (N = 40 children and adolescents with concussion symptoms >2 weeks post-injury) were recruited from the concussion services at an urban children's rehabilitation hospital and the community. The program consisted of individualized low-intensity aerobic exercise, sport-specific drills, relaxation exercises and comprehensive education and support. The 6 week program was completed by participants in their home or local community with weekly check-ins with the research team. Data were analyzed using descriptive statistics and linear regressions. MAIN OUTCOMES AND RESULTS Outcome measures included the Beck Youth Inventories (youth), and the Child Behavior Checklist (parents). Results indicated significant improvements in anger and anxiety post-intervention with anger reduction being more pronounced in girls. CONCLUSIONS Active rehabilitation interventions may have positive effects on mood in youth recovering from concussion. Clinicians may wish to consider addressing anxiety and anger management strategies as part of comprehensive concussion management in youth.
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Affiliation(s)
- Anne W Hunt
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto , Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto , Toronto, ON, Canada
| | - Sabrina Agnihotri
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto , Toronto, ON, Canada
| | - Leah Sack
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, ON, Canada
| | - Ami Tint
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, ON, Canada.,Centre for Addiction and Mental Health , Toronto, ON, Canada.,Faculty of Medicine, University of Toronto , Toronto, ON, Canada
| | - Dayna Greenspoon
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, ON, Canada
| | - Jerome Gauvin-Lepage
- Faculty of Nursing, Université De Montréal , Montreal, QC, Canada.,Research Center of the Sainte-Justine University Hospital , Montreal, QC, Canada
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University , Montreal, QC, Canada.,Division of Pediatric Emergency Medicine, Montreal Children's Hospital, McGill University Health Center , Montreal, QC, Canada
| | - Nick Reed
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto , Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto , Toronto, ON, Canada
| | - Shannon Scratch
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto , Toronto, ON, Canada
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