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Advances in concussion management
Another look at active rehabilitation for slow-to-recover sport-related concussion in children and adolescents: further evidence to support its effectiveness
  1. Isabelle Gagnon1,2,3,*
  1. 1School of Physical and Occupational Therapy, McGill University, Canada
  2. 2Trauma Programs, The Montreal Children's Hospital, McGill University Health Center Canada, Canada
  3. 3Department of Pediatrics, McGill University, Canada

    Abstract

    Objective To explore and impact of a previously developed active rehabilitation intervention for children who are slow-to-recover after concussion.

    Design Prospective repeated measures design.

    Setting The Montreal Children's Hospital Concussion Clinic.

    Participants Ten children (three girls and seven boys, mean age 14.4±1.3 years) participated in this study.

    Intervention Participants who were still symptomatic 4 weeks after the injury were involved in the active rehabilitation intervention (mean time since injury=47 days). It involves gradual, closely monitored light aerobic exercise, general coordination exercises, mental imagery, as well as reassurance and stress/anxiety reduction strategies. The program continued until complete symptom resolution at rest, at which time children and adolescents were eligible to resume the standard return to sports protocol.

    Main Outcome Measurements Primary outcome was evolution of post-concussion symptoms. Secondary outcomes included mood and energy level as well as balance and cognitive function. Those were assessed at initiation and at the end of the rehabilitation.

    Results Change in functioning was found in all domains assessed including Symptoms, Balance, Fatigue and Depressive Symptoms. Cognitive function was within normal limits at the initiation of the intervention and remained unchanged. Average duration of the intervention was 45 days (range 14–72 days).

    Conclusions Although no control group was used in this pilot study, children's functioning is improved after participation in the active rehabilitation intervention.

    Clinical Relevance The introduction of graded light intensity exercise in the post-acute period post-concussion is feasible and appears to have benefits on children's functioning.

    Acknowledgements Participants and their families, Trauma Programs of the Montreal Children's Hospital-McGill University Health Center, Fonds de la recherche du Québec-Santé; Réseau provincial de recherche en adaptation-réadaptation.

    Competing interests None.

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