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When is it time to start rehab? exploring the optimal timing to initiate active rehabilitation for concussion management in children and adolescents
  1. Isabelle Gagnon1,
  2. Danielle M. Dobney CAT (C)2,
  3. Lisa Grilli MSc PT3,
  4. Helen Kocilowicz3,
  5. Christine Beaulieu3,
  6. Meghan Straub3,
  7. Debbie Friedman4
  1. 1Kids and Teens Concussion Research Lab, The Montreal Children’s Hospital of the McGill University Health Centre,School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Canada
  2. 2School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Canada
  3. 3Trauma Centre, The Montreal Children’s Hospital, McGill University Health Centre 1001 Boulevard Décarie, Montréal, Canada
  4. 4Department of Paediatrics and Department of Paediatric Surgery, Faculty of Medicine, Trauma Programs, The Montreal Children’s Hospital of the McGill University Health Centre 1001 blvd. Decarie,McGill University, Montreal, Quebec, Canada


Objective Estimate the influence of time to initiation of active rehabilitation on post-concussion symptom (PCS) severity in youth who are slow to recover from concussion.

Design Retrospective analysis of a prospective cohort

Setting Concussion clinic of a tertiary care Paediatric Trauma Centre in Canada.

Participants 569 youth (14.3±2.3 years) with persistent PCS. Clinic patients’ information is entered prospectively in a clinical database and participants were selected for this study if they 1) participated in the active rehabilitation program, and 2) had available PCS assessments at the intake and follow-up visits.

Intervention Active rehabilitation consisting of: aerobic exercise, coordination exercises and, education/motivation. The intervention was initiated with a Physical Therapist in the Concussion clinic continued as a daily home program. The independent variable was time to initiation of the active rehabilitation program measured in weeks (2, 3, 4, 5, 6+).

Outcome measure Symptom severity measured by the PCS scale of the SCAT3 at follow-up visit, 2 weeks after initiation of intervention.Main results: Patients initiating active rehabilitation 2 weeks post-injury were significantly less symptomatic at follow-up (Mdn PCS score=5) compared to those starting five (Mdn=17) and six weeks or more (Mdn=17.5) (p=0.0002). Those starting at 3 (Mdn=9) and 4 (Mdn=10) weeks also had significantly less severe symptoms compared to those starting 6 weeks or later (p<0.05).

Conclusions The findings suggest that children benefit more from active rehabilitation if it is initiated between two and four weeks post-injury, and have poorer outcomes if it is delayed beyond 6 weeks post-injury.

Competing interests None.

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