Concussion recovery not clear cut for children
December 2, 2019
Science Daily/University of Queensland
Sleep problems, fatigue and attention difficulties in the weeks after a child's concussion injury could be a sign of reduced brain function and decreased grey matter.
Researchers from The University of Queensland have studied persistent concussion symptoms and their link to poorer recovery outcomes in children.
UQ Child Health Research Centre Research Fellow Dr Kartik Iyer said information from the study could help parents and doctors assess the risk of long-term disability.
"In the MRI scans of children with persistent concussion symptoms, poor sleep was linked to decreases in brain grey matter and reduced brain function," Dr Iyer said.
"Identifying decreases in brain function can allow us to predict if a child will recover properly.
"This knowledge can help clinicians ensure a child receives targeted rehabilitation such as cognitive behaviour therapy, medication to improve sleep, or safe and new emerging therapies such as non-invasive brain stimulation to potentially reduce symptoms."
Researchers were able to predict with 86 per cent accuracy how decreases in brain function impacted recovery two months post-concussion.
"Generally, children with persistent concussion symptoms will have alterations to their visual, motor and cognitive brain regions but we don't have a clear understanding of how this develops and how it relates to future recovery," Dr Iyer said.
"It can have a serious impact on their return to normal activities, including time away from school, difficulties with memory and attentiveness, disturbances to sleeping habits and changes to mood -- all of which affect healthy brain development."
Most children recover fully after a concussion, but one in 10 has persistent symptoms.
"It is critical that children who receive a head injury see a doctor and get professional medical advice soon after their injury has occurred," he said.
"While playing sports or riding bicycles or scooters, children should wear proper protective head gear to minimise the impact of a head injury."
For children with persistent concussion symptoms, a child-friendly non-invasive brain stimulation therapy is being trialled at UQ's KidStim laboratory.
Families interested in contacting the study team and registering their interest can contact the Acquired Brain Injury team.
https://www.sciencedaily.com/releases/2019/12/191202102046.htm
Concussion treatment: Adolescent athletes 'prescribed' aerobic exercise recovered faster
Study is the first randomized clinical trial on treatment of acute concussion
Science Daily/February 4, 2019
University at Buffalo
Adolescent athletes who sustained concussions while playing a sport recovered more quickly when they underwent a supervised, aerobic exercise regimen.
The study, by University at Buffalo researchers and colleagues, is the first randomized clinical trial of a treatment in the acute phase after a sport-related concussion. The goal was to evaluate prescribed, progressive sub-symptom threshold exercise as a treatment within the first week of a concussion in adolescents after a few days of rest. Sub-symptom threshold exercise is physical activity that doesn't exacerbate symptoms.
The researchers followed 103 participants ages 13-18, with nearly the same number of males and females. All were seen within 10 days after sustaining a sport-related concussion at one of the UBMD Orthopaedics and Sports Medicine clinics in Western New York or at the Pan Am Clinic in Winnipeg.
Patients who followed the aerobic exercise program took on average 13 days to recover while those in the control group, who performed stretching exercises, took 17 days. In addition, fewer patients in the exercise program took longer than four weeks to recover than did patients in the control group.
"This research provides the strongest evidence yet that a prescribed, individualized aerobic exercise program that keeps the heart rate below the point where symptoms worsen is the best way to treat concussion in adolescents," said John J. Leddy, MD, first author, clinical professor of orthopaedics in the Jacobs School of Medicine and Biomedical Sciences at UB, and director of the UB Concussion Management Clinic at UBMD Orthopaedics and Sports Medicine.
The researchers plan to investigate if the treatment is also effective in adults with concussion.
No proven treatment
The researchers noted that there is no proven treatment for concussion, especially among adolescents, who typically take the longest to recover.
"Until now, nothing else has been proven in any way effective for treating concussion," said Barry S. Willer, PhD, senior author, director of research in the UB Concussion Management Clinic and professor of psychiatry in the Jacobs School. "This is the best evidence so far for a treatment that works."
The findings directly contradict the conventional approach to concussion, which often consists of nearly total rest, eliminating most physical and mental activities, including schoolwork.
"Telling a teenager to go home and basically do nothing is depressing," said Willer. "It can actually increase their physical and psychological symptoms, and we see that particularly among girls. But with our approach, you're saying, sure, you can return to school and you should start doing these exercises. Their chins are up, Mom and Dad are happy and so is the student."
The fact that all states have now passed laws requiring schools to make accommodations for students who have sustained concussions is also helpful, said Willer, so that the student can opt out of some activities during the school day, if necessary.
The proper 'dose' of exercise
To determine how much exercise each patient could sustain without exacerbating symptoms, the researchers had each one undergo the Buffalo Concussion Treadmill Test, developed by Leddy and Willer, to determine at what level their symptoms worsen. As the patient walks on a treadmill, the incline is gradually increased and the heart rate is recorded at the point where concussion symptoms intensify.
"We prescribed exercise at 80 percent of that threshold," Leddy explained, "so each patient's exercise 'dose' was individually tailored."
Patients were randomly assigned to the aerobic exercise group (52) or to a stretching group (51). Patients in both groups were sent home with a heart rate monitor so they could make sure they stayed below the threshold while exercising.
Both groups performed their assigned exercise for about 20 minutes each day and were required to report compliance and daily symptoms online. Those in the aerobic group either walked on a treadmill, rode a stationary bike, or walked either inside or out. Aside from the prescribed exercise, patients were advised to refrain from contact sports, gym class or team practice. They were given advice about getting schoolwork done and told to avoid excessive use of electronic devices, since that can also aggravate symptoms.
Each patient's condition was re-evaluated weekly and as symptoms improved, the "dose" of exercise or stretching was increased, according to the weekly treadmill test results.
Recovery was rigorously defined, requiring agreement among three independent criteria: the patient's reporting a normal (minimal) level of symptoms, a normal physical examination by a medical doctor, and the return of normal exercise tolerance on the Buffalo Concussion Treadmill Test. The physicians were blinded as to the group assignment of each participant.
One surprising finding was that only two participants out of 52 (4 percent) in the aerobic exercise group took longer than four weeks to recover compared to seven out of 51 (14 percent) in the stretching group. This did not reach statistical significance, but the scientific literature suggests, by contrast, that between 15 and 25 percent of adolescents who do not receive any treatment will be symptomatic past four weeks.
"Reducing the number of concussed adolescents who have delayed recovery has major implications," Willer said, noting that delayed recovery creates more difficulty with schoolwork, can lead to depression and puts additional demands on the health care system and its costs.
Expanding capacity for medically supervised exercise treatment
Michael J. Ellis, MD, co-author and medical director of the Pan Am Concussion Program in the Department of Surgery and Pediatrics at the University of Manitoba, said that for years, his clinic has been successfully using the Buffalo Concussion Treadmill Test and a medically supervised sub-symptom-threshold aerobic exercise program to treat professional, collegiate and elite adolescent athletes.
Expanding access to this treatment is now critical, he said.
"The results of this study suggest that we must build greater capacity within our health care systems to allow patients access to multidisciplinary concussion programs and clinics that have the medical expertise to carry out early targeted rehabilitation of acute concussion," he said.
Leddy and Willer are internationally known for their research into the best ways to diagnose and treat concussion, especially among adolescents, who are the most vulnerable age group for concussions and take the longest time to recover. They have led the emerging body of research findings that show that a patient's degree of exercise intolerance in the first week after injury, i.e., the lower the threshold of activity at which symptoms increase, is a key clinical indicator of how severe the concussion may be.
https://www.sciencedaily.com/releases/2019/02/190204114615.htm
Many parents in the dark about concussions
Concussion affects children in numerous sports
July 13, 2017
Science Daily/University of Texas at Arlington
Despite the large volume of information about sports related concussions on the Internet, many parents and guardians of young athletes have a limited understanding of concussions, according to a study.
In the study, which was published in May in the Journal of Applied Behavioral Research, Cynthia Trowbridge, an associate professor of kinesiology and athletic trainer, and co-author Sheetal J. Patel of Stanford University, found that a significant number of caregivers have a limited understanding of concussions and their impact on a child's future.
"They did understand that it's a severe injury but they didn't understand how susceptible patients are," said Trowbridge, a noted expert on concussions in middle and high school athletes. "We found out that despite the fact that all parents had read some brochure or seen some TV show about concussions they had a low self efficacy about awareness. They tended not to know that concussions are associated with all sports, including track and field, volleyball and swimming."
Sports related concussions account for 53 percent of all head injuries in young people under the age of 19, according to the U.S. Centers for Disease Control. The CDC estimates that there are between 1.6 and 3.8 million sports related injuries among young people each year.
Concussions have received heightened attention in recent years because of the large number of retired professional football players who have sued the National Football League. These retired players claim that in some instances they were sent back into games despite the fact that their coaches knew there was a reasonable chance they may have suffered concussions on the gridiron.
In each of the 50 states there are laws requiring teams to take out athletes who may have suffered concussions. The decision is often made by members of the concussion care team, a group of objective health care professionals that includes a physician, an advanced practice nurse and an athletic trainer.
"We live in an age in which parents recognize more than ever the importance of athletics in instilling skills like discipline, concentration, team work and leadership in young people," said Anne Bavier, dean of the College of Nursing and Health Innovation. "But we need to be just as mindful about the kinds of dangerous, unseen injuries that come from playing sports. This study is a useful tool for building awareness and arming parents with some really good information."
Trowbridge said they were motivated to do the study to find out what caregivers understand about concussions and how to better educate them so they can be more effective in looking for symptoms or other possible signs of trouble.
"It's important to involve not only the athletes but the caregivers," said Trowbridge. "It is the caregiver that knows the child the best and can often recognize the signs and symptoms."
She added that studies show many young athletes do not always tell the truth about their symptoms because they want to continue playing.
"We are still learning how concussion symptoms resolve but we know that they don't get better by sending someone right back in with symptoms," Trowbridge said. "Sports is so magical and so many things can be learned from sports, but we have to give the caregivers the tools to be able to protect the youth athlete when they can't protect themselves."
Trowbridge said caregivers should be discriminating when picking physicians to examine their children for possible concussions, adding that not all physicians understand concussions. She encourages them to consult with neurologists, primary care physicians who specialize in sports medicine and concussion specialists when seeking medical advice.
https://www.sciencedaily.com/releases/2017/07/170713154828.htm