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Developmental Considerations in Pediatric Concussion Evaluation and Management

  • Gerard A. Gioia
  • Christopher G. Vaughan
  • Maegan D. S. Sady
Chapter

Abstract

Evaluation and management of concussion in the child and adolescent requires a developmentally appropriate clinical model, emphasizing key factors relevant to the injury manifestation and needs of the child. This chapter presents a model for clinical evaluation and management of concussion in children and adolescents at the acute and postacute stages. Multiple methods and informants are incorporated with the evaluation guided by the specific goals and timing of the service in relation to the injury. Appropriate assessment and intervention tools are discussed for each stage, as well as reasons for referral for additional levels of care. The fundamental components of a pediatric concussion evaluation include the following: definition of injury characteristics; history of premorbid and postinjury risk factors; assessment of current neurocognitive functioning, postconcussion symptoms, and balance; and examination of social–emotional functioning. Different disciplines contribute to the evaluation and management of pediatric concussion. The concept of the concussion generalist and specialist service is introduced with suggested requisite training, skills, and knowledge to evaluate and manage the full range of complexity of pediatric concussion.

Keywords

Anterograde Amnesia Injury Characteristic Service Goal High Risk Activity Concussive Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Anderson, V., Catroppa, C., Morse, S., et al. (2001). Outcome from mild head injury in young children: a prospective study. Journal of Clinical and Experimental Neuropsychology, 23, 705–717.PubMedCrossRefGoogle Scholar
  2. Babikian, T., & Asarnow, R. (2009). Neurocognitive outcomes and recovery after pediatric TBI: Meta-analytic review of the literature. Neuropsychology, 23, 283–296.PubMedCrossRefGoogle Scholar
  3. Bernstein J.H., Waber D.P. (1990). Developmental neuropsychological assessment. In: Boulton A.A., Baker G.B., Hiscock M. (Eds.) Neuropsychology: Vol. 17. Neuromethods. Clifton NJ:Humana Press.Google Scholar
  4. Bieri, D., Reeve, R., Champion, G. D., et al. (1990). The faces pain scale for the self-assessment of the severity of pain experienced by children: development, initial validation and preliminary investigation for ratio scale properties. Pain, 41, 139–150.PubMedCrossRefGoogle Scholar
  5. Camiolo Reddy, C., Collins, M. W., & Gioia, G. A. (2008). Adolescent sports concussion. Physical Medicine and Rehabilitation Clinics of North America, 19, 247–269.CrossRefGoogle Scholar
  6. Catroppa, C., Anderson, V., Morse, S., et al. (2007). Children’s attentional skills 5 years post-TBI. Journal of Pediatric Psychology, 32, 354–369.PubMedCrossRefGoogle Scholar
  7. Centers for Disease Control and Prevention (CDC) (2007). National Center for Injury Prevention and Control. Heads Up: Brain Injury in your Practice. Facts for Physicians. Atlanta, Center for Disease Control and Prevention. Available via http://www.cdc.gov/ncipc/tbi/Physicians_Tool_Kit.htm. Cited 1 Feb 2011.
  8. Collie, A., Darby, D., & Maruff, P. (2001). Computerized cognitive assessment of athletes with sports related head injury. British Journal of Sports Medicine, 35, 297–302.PubMedCrossRefGoogle Scholar
  9. Collie, A., & Maruff, P. (2003). Computerized cognitive assessment of concussed Australian Rules footballers. British Journal of Sports Medicine, 37, 2–3.PubMedCrossRefGoogle Scholar
  10. Collins, M. W., Lovell, M. R., Iverson, G. L., et al. (2002). Cumulative effects of concussion in high school athletes. Neurosurgery, 51, 1175–1179.PubMedCrossRefGoogle Scholar
  11. Collins, M. W., Lovell, M. R., Iverson, G. L., et al. (2006). Examining concussion rates and return to play in high school football players wearing newer helmet technology: a three year prospective cohort study. Neurosurgery, 58, 275–283.PubMedCrossRefGoogle Scholar
  12. Collins, M. W., Lovell, M. R., & McKeag, D. B. (1999). Current issues in managing sports-related concussion. Journal of the American Medical Association, 282, 2283–2285.PubMedCrossRefGoogle Scholar
  13. Comper, P., Bisschop, S. M., Carnide, N., et al. (2005). A systematic review of treatments for mild traumatic brain injury. Brain Injury, 19, 863–880.PubMedCrossRefGoogle Scholar
  14. De Los Reyes, A., & Kazdin, A. E. (2005). Informant discrepancies in the assessment of childhood psychopathology: a critical review, theoretical framework and recommendations for further study. Psychological Bulletin, 131, 483–509.CrossRefGoogle Scholar
  15. Echemendia, R. J., & Julian, L. J. (2001). Mild traumatic brain injury in sports: Neuropsychology’s contribution to a developing field. Neuropsychology Review, 11, 69–88.PubMedCrossRefGoogle Scholar
  16. Fay, T. B., Yeates, K. O., Taylor, H. G., et al. (2010). Cognitive reserve as a moderator of postconcussive symptoms in children with complicated and uncomplicated mild traumatic brain injury. Journal of International Neuropsychological Society, 16, 94–105.CrossRefGoogle Scholar
  17. Fay, T. B., Yeates, K. O., Wade, S. L., et al. (2009). Predicting longitudinal patterns of functional deficits in children with traumatic brain injury. Neuropsychology, 23, 271–282.PubMedCrossRefGoogle Scholar
  18. Fazio, V. C., Lovell, M. R., Pardini, J. E., et al. (2007). The relation between post concussion symptoms and neurocognitive performance in concussed athletes. NeuroRehabilitation, 22, 207–216.PubMedGoogle Scholar
  19. Field, M., Lovell, M. W., Collins, M. R., et al. (2003). Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes. The Journal of Pediatrics, 142, 546–553.PubMedCrossRefGoogle Scholar
  20. Fritz, G. K., Yeung, A., Wamboldt, M. Z., et al. (1996). Conceptual and methodologic issues in quantifying perceptual accuracy in childhood asthma. Journal of Pediatric Psychology, 21, 153–173.PubMedCrossRefGoogle Scholar
  21. Frommer, L. J., Gurka, K. K., Cross, K. M., et al. (2011). Sex differences in concussion symptoms of high school athletes. Journal of Athletic Training, 46, 76–84.PubMedCrossRefGoogle Scholar
  22. Gagnon, I., Swaine, B., Friedman, D., et al. (2004). Children demonstrate decreased dynamic balance following a mild traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 85, 444–452.PubMedCrossRefGoogle Scholar
  23. Gioia, G. A., Collins, M. W., & Isquith, P. K. (2008a). Improving identification and diagnosis of mild TBI with evidence: Psychometric support for the Acute Concussion Evaluation (ACE). The Journal of Head Trauma Rehabilitation, 23, 230–242.PubMedCrossRefGoogle Scholar
  24. Gioia, G. A., Isquith, P. K., Schneider, J. C., et al. (2009a). Initial validation of a pediatric version of the Immediate Post Concussion Assessment and Cognitive Testing (ImPACT) Battery [Abstract]. British Journal of Sports Medicine, 43(Suppl 1), i92.Google Scholar
  25. Gioia, G. A., Janusz, J. A., Isquith, P. K., et al. (2008b). Psychometric properties of the parent and teacher post-concussion symptom inventory (PCSI) for children and adolescents. Journal of International Neuropsychological Society, 14(Suppl. 1), 204.Google Scholar
  26. Gioia, G. A., Schneider, J. C., Vaughan, C. G., et al. (2009b). Which symptom assessments and approaches are uniquely appropriate for paediatric concussion. British Journal of Sports Medicine, 43(Suppl I), 13–22.CrossRefGoogle Scholar
  27. Gioia, G. A., Vaughan, C. G., & Isquith, P. K. (2011). Manual for pediatric immediate post-concussion assessment and cognitive testing. Pittsburgh, PA: ImPACT Applications, Inc.PubMedCrossRefGoogle Scholar
  28. Giza, C., & Prins, M. L. (2006). Is being plastic fantastic? Mechanisms of altered plasticity after developmental TBI. Developmental Neuroscience, 28, 364–379.PubMedCrossRefGoogle Scholar
  29. Guskiewicz, K. M., Perrin, D. H., & Gansneder, B. M. (1996). Effect of mild head injury on postural stability in athletes. Journal of Athletic Training, 31, 300–306.PubMedGoogle Scholar
  30. Guskiewicz, K. M., Ross, S. E., & Marshall, S. W. (2001). Postural stability and neuropsychological deficits after concussion in collegiate athletes. Journal of Athletic Training, 36, 263–273.PubMedGoogle Scholar
  31. Hajek, C. A., Yeates, K. O., Taylor, H. G., et al. (2011). Agreement between parents and children on ratings of post-concussive symptoms following mild traumatic brain injury. Child Neuropsychology, 17, 17–33.PubMedCrossRefGoogle Scholar
  32. Halstead, M. E., & Walter, K. D. (2010). Sport-related concussion in children and adolescents. Pediatrics, 126, 597–615.PubMedCrossRefGoogle Scholar
  33. Hawley, C. A., Ward, A. B., Magnay, A. R., et al. (2003). Parental stress and burden following traumatic brain injury amongst children and adolescents. Brain Injury, 17, 1–23.PubMedCrossRefGoogle Scholar
  34. Hessen, E., Nestvold, K., & Sundet, K. (2006). Neuropsychological function in a group of patients 25 years after sustaining minor head injuries as children and adolescents. Scandinavian Journal of Psychology, 47, 245–251.PubMedCrossRefGoogle Scholar
  35. Iverson, G. L., Brooks, B. L., Collins, M. W., et al. (2006). Tracking neuropsychological recovery following concussion in sport. Brain Injury, 20, 245–252.PubMedCrossRefGoogle Scholar
  36. Kirkwood, M. W., Yeates, K. O., Taylor, H. G., et al. (2008). Management of pediatric mild traumatic brain injury: a neuropsychological review from injury through recovery. Clinical Neuropsychology, 22, 769–800.CrossRefGoogle Scholar
  37. Kirkwood, M. W., Yeates, K. O., & Wilson, P. E. (2006). Pediatric sport-related concussion: a review of the clinical management of an oft-neglected population. Pediatrics, 117, 1359–1371.PubMedCrossRefGoogle Scholar
  38. Light, R., Asarnow, R. F., Satz, P., et al. (1998). Mild closed-head injury in children and adolescents: behavior problems and academic outcomes. Journal of Consulting and Clinical Psychology, 66, 1023–1029.PubMedCrossRefGoogle Scholar
  39. Lovell, M. R. (2008). The neurophysiology and assessment of sports-related head injuries. Neurologic Clinics, 26, 45–62.PubMedCrossRefGoogle Scholar
  40. Lovell, M. R., Collins, M. W., Iverson, G. L., et al. (2003). Recovery from mild concussion in high school athletes. Journal of Neurosurgery, 98, 295–301.CrossRefGoogle Scholar
  41. Lovell M, Collins M, Maroon J (2002). ImPACT: The best approach to concussion management, Version 2.1 User’s Manual. Pittsburgh PA: Impact Test.Google Scholar
  42. Lovell, M. R., & Fazio, V. (2008). Concussion management in the child and adolescent athlete. Current Sports Medicine Reports, 7, 12–15.PubMedGoogle Scholar
  43. Lovell, M. R., Iverson, G. L., Collins, M. W., et al. (2006). Measurement of symptoms following sport-related concussion: reliability and normative data for the post-concussion scale. Applied Neuropsychology, 13, 166–174.PubMedCrossRefGoogle Scholar
  44. Mainwaring, L. M., Bisschop, S. M., Green, R. E., et al. (2004). Emotional reaction of varsity athletes to sport-related concussion. Journal of Sport and Exercise Psychology, 26, 119–135.Google Scholar
  45. Majerske, C. W., Mihalik, J. P., Ren, D., et al. (2008). Concussion in sports: postconcussive activity levels, symptoms, and neurocognitive performance. Journal of Athletic Training, 43, 265–274.PubMedCrossRefGoogle Scholar
  46. Maroon, J. R., Lovell, M. R., Norwig, J., et al. (2000). Cerebral concussion in athletes: evaluation and neuropsychological testing. Neurosurgery, 47, 659–669.PubMedGoogle Scholar
  47. Massagli, T. L., Fann, J. R., Burington, B. E., et al. (2004). Psychiatric illness after mild traumatic brain injury in children. Archives of Physical Medicine and Rehabilitation, 85, 1428–1434.PubMedCrossRefGoogle Scholar
  48. McCrea, M. (2008). Mild traumatic brain injury and postconcussion syndrome. New York: Oxford University Press.Google Scholar
  49. McCrea, M., Barr, W. B., Guskiewicz, K., et al. (2005). Standard regression-based methods for measuring recovery after sports-related concussion. Journal of International Neuropsychological Society, 11, 58–69.CrossRefGoogle Scholar
  50. McCrea, M., Hammeke, T. A., Olsen, G., et al. (2004). Unreported concussion in high school football players: implications for prevention. Clinical Journal of Sport Medicine, 14, 13–17.PubMedCrossRefGoogle Scholar
  51. McCrory, P., Makdissi, M., Davis, G., et al. (2005). Value of neuropsychological testing after head injuries in football. British Journal of Sports Medicine, 39(Suppl), 58–63.CrossRefGoogle Scholar
  52. McKinlay, A., Dalrymple-Alford, J. C., Horwood, L. J., et al. (2002). Long term psychosocial outcomes after mild head injury in early childhood. Journal of Neurology, Neurosurgery, and Psychiatry, 73, 281–288.PubMedCrossRefGoogle Scholar
  53. Mihalik, J. P., Stump, J. E., Collins, M. W., et al. (2005). Posttraumatic migraine characteristics in athletes following sports-related concussion. Journal of Neurosurgery, 102, 850–855.PubMedCrossRefGoogle Scholar
  54. Moser, R. S., Schatz, P., & Jordan, B. D. (2005). Prolonged effects of concussion in high school athletes. Neurosurgery, 57, 300–306.PubMedCrossRefGoogle Scholar
  55. Pellman, E. J., Lovell, M. R., Viano, D. C., et al. (2006). Concussion in professional football: recovery in NFL and high school athletes assessed by computerized neuropsychological testing. Neurosurgery, 58, 263–274.PubMedCrossRefGoogle Scholar
  56. Ponsford, J., Willmott, C., Rothwell, A., et al. (1999). Cognitive and behavioral outcome following mild traumatic head injury in children. The Journal of Head Trauma Rehabilitation, 14, 360–372.PubMedCrossRefGoogle Scholar
  57. Ponsford, J., Willmott, C., Rothwell, A., et al. (2001). Impact of early intervention on outcome after mild traumatic brain injury in children. Pediatrics, 108, 1297–1303.PubMedCrossRefGoogle Scholar
  58. Riemann, B. L., & Guskiewicz, K. M. (2000). Effects of mild head injury on postural stability as measured through clinical balance testing. Journal of Athletic Training, 35, 19–25.PubMedGoogle Scholar
  59. Riemann, B. L., Guskiewicz, K. M., & Shields, E. W. (1999). Relationship between clinical and forceplate measures of postural stability. Journal of Sport Rehabilitation, 8, 71–82.Google Scholar
  60. Satz, P., Zaucha, K., McCleary, C., et al. (1997). Mild head injury in children and adolescents: a review of studies (1970–1995). Psychological Bulletin, 122, 107–131.PubMedCrossRefGoogle Scholar
  61. Schatz, P., Pardini, J. E., Lovell, M. R., et al. (2006). Sensitivity and specificity of the ImPACT test battery for concussion in athletes. Archives of Clinical Neuropsychology, 21, 91–99.PubMedCrossRefGoogle Scholar
  62. Swaine, B. R., Tremblay, C., Platt, R. W., et al. (2007). Previous head injury is a risk factor for subsequent head injury in children: a longitudinal cohort study. Pediatrics, 119, 749–758.PubMedCrossRefGoogle Scholar
  63. Taylor, H. G., Dietrich, A., Nuss, K., et al. (2010). Post-concussive symptoms in children with mild traumatic brain injury. Neuropsychology, 24, 148–159.PubMedCrossRefGoogle Scholar
  64. Turkstra, L. S., Coelho, C., & Ylvisaker, M. (2005). The use of standardized tests for individuals with cognitive-communication disorders. Seminars in Speech and Language, 26, 215–222.PubMedCrossRefGoogle Scholar
  65. Upton, P., Lawford, J., & Eiser, C. (2008). Parent-child agreement across child health-related quality of life instruments: a review of the literature. Quality of Life Research, 17, 895–913.PubMedCrossRefGoogle Scholar
  66. van Kampen, D. A., Lovell, M. R., Pardini, J. E., et al. (2006). The “value added” of neurocognitive testing after sports-related concussion. The American Journal of Sports Medicine, 34(10), 1630–1635.PubMedCrossRefGoogle Scholar
  67. Varni, J. W., Limbers, C. A., & Burwinkle, T. M. (2007a). How young can children reliably and validly self-report their health-related quality of life?: An analysis of 8,591 children across age subgroups with the PedsQL™ 4.0 generic core scales. Health and Quality of Life Outcomes, 5, 1.PubMedCrossRefGoogle Scholar
  68. Varni, J. W., Limbers, C. A., & Burwinkle, T. M. (2007b). Parent proxy-report of their children’s health-related quality of life: An analysis of 13,878 parents’ reliability and validity across age subgroups using the PedsQL™ 4.0 Generic Core Scales. Health and Quality of Life Outcomes, 5, 2.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Gerard A. Gioia
    • 1
    • 2
  • Christopher G. Vaughan
    • 3
    • 2
  • Maegan D. S. Sady
    • 4
  1. 1.Division of Pediatric NeuropsychologyDirector Safe Concussion Outcome Recovery and Education (SCORE) ProgramWashingtonUSA
  2. 2.Departments of Pediatric and Psychiatry and Behavioral SciencesGeorge Washington University of MedicineWashingtonUSA
  3. 3.Division of Pediatric NeuropsychologyChildren’s National Medical CenterWashingtonUSA
  4. 4.Division of Pediatric NeuropsychologyChildren’s National Medical CenterWashingtonUSA

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