BACKGROUND: The amount of literature dealing with the diagnosis and treatment of adolescent concussions is considerable. Most articles focus on the athlete. This study examines both sports-related and nonsports-related concussions in adolescents, their etiology, mechanisms of injury (categorized by sport), symptoms exhibited, physical findings, computerized tomography scan results and the problem of prolonged recovery (persistent postconcussion syndrome used in this article to mean symptoms lasting over four weeks.) OBJECTIVE: The purpose of this study is to present the data, their significance and a new method of management that has successfully allowed the author's concussed patients to recover more rapidly. METHOD: A retrospective review of 863 adolescent concussions, in 11-year-old to 19-year-old patients, from July 2004 through December 31, 2008. Subjects were seen as a result of referrals largely from the author's practice (Pediatric Healthcare Associates), other physicians, athletic trainers or patients previously treated. All concussions, including nonsports-related concussions, were included in the study. Some patients had multiple concussions; 774 individuals accounted for the 863 concussions. The number of patients by age and the number of concussions they sustained are listed below.
Available from: Douglas Glenn Chang
- "The Center for Disease Control recommends cognitive rest to last 24 to 48 hours, and then began a stepwise return to normal activity ("Sports Concussion , " 2013). Many clinicians recommend a stricter definition of rest for a prolonged duration (rest lasting until complete symptom resolution) (Brunk, 2014; Lee & Fine, 2010). A strict definition of rest includes no school, no homework or tests, no travel or shopping or trips outside of the home, no driving, no visits with friends or social visits in or outside of the home, increased sleep, significant reduction of television viewing and no watching athletic games or other visually intense movies, no video games, no computer usage, no texting, phone calls only if necessary, and no reading unless minor in nature (such as reading directions on a medication bottle). "
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ABSTRACT: Cognitive rest is the recommendation for all patients with acute sports concussion. A comprehensive literature search was conducted for the research question “What is the optimal type and amount of cognitive rest for patients with a sports concussion?” Seven studies met the inclusion criteria. Six studies were observational or case series without comparison control groups. These represent lower quality research, and present conflicting data on the effect of cognitive load on recovery. The authors suggest the concept of active cognitive rehabilitation for one area of future research for sports concussion injuries.
Available from: Kim M Cecil
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ABSTRACT: The pathophysiology of sports-related concussion (SRC) is incompletely understood. Human adult and experimental animal investigations have revealed structural axonal injuries, decreases in the neuronal metabolite N-acetyl aspartate, and reduced cerebral blood flow (CBF) after SRC and minor traumatic brain injury. The authors of this investigation explore these possibilities after pediatric SRC.
Twelve children, ages 11 to 15 years, who experienced SRC were evaluated by ImPACT neurocognitive testing, T1 and susceptibility weighted MRI, diffusion tensor imaging, proton magnetic resonance spectroscopy, and phase contrast angiography at <72 hours, 14 days, and 30 days or greater after concussion. A similar number of age- and gender-matched controls were evaluated at a single time point.
ImPACT results confirmed statistically significant differences in initial total symptom score and reaction time between the SRC and control groups, resolving by 14 days for total symptom score and 30 days for reaction time. No evidence of structural injury was found on qualitative review of MRI. No decreases in neuronal metabolite N-acetyl aspartate or elevation of lactic acid were detected by proton magnetic resonance spectroscopy. Statistically significant alterations in CBF were documented in the SRC group, with reduction in CBF predominating (38 vs 48 mL/100 g per minute; P = .027). Improvement toward control values occurred in only 27% of the participants at 14 days and 64% at >30 days after SRC.
Pediatric SRC is primarily a physiologic injury, affecting CBF significantly without evidence of measurable structural, metabolic neuronal or axonal injury. Further study of CBF mechanisms is needed to explain patterns of recovery.
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ABSTRACT: OBJECTIVE To identify predictors of persistent concussion symptoms (PCS) in children following concussion. DATA SOURCES We searched MEDLINE, Embase, and the Cochrane Library to April 2012. STUDY SELECTION A systematic review of the literature to identify prognosticators of PCS following pediatric concussion was conducted. Studies evaluating patients aged 2 years to 18 years with PCS were eligible. MAIN OUTCOME MEASURES The association of clinically available factors with PCS development. RESULTS A literature search yielded 824 records; 561 remained after removal of duplicates. Fifteen studies were included in descriptive analysis; heterogeneity precluded a meta-analysis. Larger prospective studies concluded that the risk for PCS was increased in older children with loss of consciousness, headache, and/or nausea/vomiting. Smaller studies noted that initial dizziness may predict PCS. Patients with premorbid conditions (eg, previous head injury, learning difficulties, or behavioral problems) may also have increased risk. CONCLUSIONS Minimal, and at times contradictory, evidence exists to associate clinically available factors with eventual development of PCS in children. Future trials must be adequately powered to determine which variables best predict the time to full symptom resolution. Expert consensus should delineate which postconcussion assessment measures are preferred to reduce heterogeneity going forward. Research to improve care for the epidemic of pediatric concussion depends on early identification of those most in need of intervention.
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