Advertisement

Postinjury Issues and Ethics of Return to Play in Pediatric Concussion

  • Jennifer Niskala Apps
  • Kevin D. Walter
  • Jason S. Doescher
Chapter

Abstract

Concussion management is an individualized process and therefore can be confusing to patients, parents, and other caregivers. There are guidelines to assist in identifying concussion symptoms and suggest return-to-play plans, but each patient deserves a unique approach to their injury. This chapter reviews the potential long-term complications of concussion, including chronic traumatic encephalopathy, chronic headaches, and neurocognitive dysfunction. It also explores the possible management options for concussed children and adolescents, many of which are emerging and somewhat experimental. Long-term psychosocial concerns are addressed. The ethics of return-to-play are also discussed.

Keywords

Young Athlete Chronic Traumatic Encephalopathy National Football League Posttraumatic Headache Vestibular Rehabilitation 
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. Alsalaheen, B. A., Mucha, A., Morris, L. O., et al. (2010). Vestibular rehabilitation for dizziness and balance disorders after concussion. Journal of Neurologic Physical Therapy, 34, 87–93.PubMedGoogle Scholar
  2. Annegers, J. F., & Coan, S. P. (2000). The risks of epilepsy after traumatic brain injury. Seizure, 9, 453–457.PubMedCrossRefGoogle Scholar
  3. Bailes, J. E., & Mills, J. D. (2010). Docosahexaenoic acid reduces traumatic axonal injury in a rodent head injury model. Journal of Neurotrauma, 27, 1617–1624.PubMedCrossRefGoogle Scholar
  4. Bailey, C. M., Samples, H. L., Broschek D. K., et al. (2010). The relationship between psychological distress and baseline sports-related concussion testing. Clinical Journal of Sport Medicine, 20(4), 272–277.PubMedCrossRefGoogle Scholar
  5. Casson IR. Do the ‘facts’ really support an association between NFL players’ concussions, dementia and depression? Neurology Today 2010; June: 6–7.Google Scholar
  6. Cantu, R. C. (2009). When to disqualify an athlete after a concussion. Current Sports Medicine Reports, 8(1), 6–7.PubMedGoogle Scholar
  7. Cantu, R. C. (2003). Recurrent athletic head injury risks and when to retire. Clinics in Sports Medicine, 22(3), 593–603.PubMedCrossRefGoogle Scholar
  8. Christensen, J., Pedersen, M. G., Pederen, C. B., et al. (2009). Long-term risk of epilepsy after traumatic brain injury in children and young adults: a population-based cohort study. The Lancet, 373, 1105–1110.CrossRefGoogle Scholar
  9. Cifu, D. X., Cohen, S. I., Lew, H. L., et al. (2010). The history and evolution of traumatic brain injury rehabilitation in military service members and veterans. American Journal of Physical Medicine and Rehabilitation, 89, 688–694.PubMedCrossRefGoogle Scholar
  10. Ferguson, P. L., Smith, G. M., Wannamake, B. B., et al. (2009). A population-based study of the risk of epilepsy after hospitalization for traumatic brain injury. Epilepsia, 51, 891–898.PubMedGoogle Scholar
  11. Gagnon, I., Galli, C., Friedman, D., et al. (2009). Active rehabilitation for children who are slow to recover following sport-related concussion. Brain Injury, 23, 956–964.PubMedCrossRefGoogle Scholar
  12. Gordon, K. E., & Apolipoprotein, E. (2010). Apolipoprotein E genotyping and concussion: time to fish or cut bait. Clinical Journal of Sport Medicine, 20, 405–6.PubMedCrossRefGoogle Scholar
  13. Guskiewicz, K., McCrea, M., Marshall, S., et al. (2003). Cumulative effects associated with recurrent concussion in collegiate football players. JAMA, 290, 2549–2555.PubMedCrossRefGoogle Scholar
  14. Halstead, M. E., Walter, K. D., et al. (2010). Clinical report – sport-related concussion in children and adolescents. Pediatrics, 126, 597–615.PubMedCrossRefGoogle Scholar
  15. Jordan, B. D., Relkin, N. R., Ravdin, L. D., et al. (1997). Apolipoprotein E epsilon 4 associated with chronic traumatic brain injury in boxing. JAMA, 278(2), 136–140.PubMedCrossRefGoogle Scholar
  16. Kim, J., Basak, J. M., & Holtzman, D. M. (2009). The role of apolipoprotein E in Alzheimer’s disease. Neuron, 63, 287–303.PubMedCrossRefGoogle Scholar
  17. Leddy, J. J., Baker, J. G., Kozlowski, K., et al. (2011). Reliability of a graded exercise test for assessing recovery from concussion. Clinical Journal of Sport Medicine, 21, 89–94.PubMedCrossRefGoogle Scholar
  18. Leddy, J. J., Kozlowski, K., Donnelly, J., et al. (2010). A preliminary study of subsymptom threshold exercise training for refractory post-concussion syndrome. Clinical Journal of Sport Medicine, 20, 21–27.PubMedCrossRefGoogle Scholar
  19. Martland, H. S. (1928). Punch drunk. JAMA, 91, 1103–1107.CrossRefGoogle Scholar
  20. McCrory, P. (2011). When to retire after concussion? British Journal of Sports Medicine, 45(6), 380–382.Google Scholar
  21. McCrory, P., Meeuwisse, W., Johnston, K., et al. (2009). Consensus statement on concussion in sport: The 3 rd International Conference on Concussion in Sport held in Zurich, November 2008. British Journal of Sports Medicine, 43(Suppl 1), 76–84.CrossRefGoogle Scholar
  22. McKee, A., Cantu, R., Nowinski, C., et al. (2009). Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. Journal of Neuropathology and Experimental Neurology, 68, 709–735.PubMedCrossRefGoogle Scholar
  23. McKee AC. Chronic traumatic encephalopathy and chronic traumatic encephalomyelopathy. Presented at the 2011 University of Wisconsin Sports Medicine Symposium, April 7, 2011.Google Scholar
  24. Nampiaparampil, D. E. (2008). Prevalence of chronic pain after traumatic brain injury. JAMA, 300, 711–719.PubMedCrossRefGoogle Scholar
  25. Omalu, B. I., DeKosky, S. T., Minster, R. L., et al. (2005). Chronic traumatic encephalopathy in a National Football League player. Neurosurgery, 57(1), 128–134.PubMedCrossRefGoogle Scholar
  26. Omalu, B. I., Hamilton, R. L., Kamboch, M. I., et al. (2010). Chronic traumatic encephalopathy in a national football league player: case report and emerging medicolegal practice questions. Journal of Forensic Nursing, 6, 40–46.PubMedCrossRefGoogle Scholar
  27. Stovner, L. J., Schrader, H., Mickeviciene, D., et al. (2008). Headache after concussion. European Journal of Neurology, 16, 112–120.CrossRefGoogle Scholar
  28. Teasdale, G. M., Nicoll, J. A., Murray, G., et al. (1997). Association of apolipoprotein E polymorphism with outcome after head injury. The Lancet, 350, 1069–1071.CrossRefGoogle Scholar
  29. Terrell, T. R., Bostick, R. M., Abramson, R., et al. (2008). APOE, APOE promoter, and tau genotypes and risk for concussion in college athletes. Clinical Journal of Sport Medicine, 18, 10–17.PubMedCrossRefGoogle Scholar
  30. Tierney, R., Mansell, J. L., Higgins, M., et al. (2010). APOE genotype and concussion in college athletes. Clinical Journal of Sport Medicine, 20, 464–468.PubMedCrossRefGoogle Scholar
  31. Warner, J. S., & Fenichel, G. M. (1996). Chronic post-traumatic headache often a myth? Neurology, 46, 915–916.PubMedGoogle Scholar
  32. Weiss, H. D., Stern, B. J., & Goldberg, J. (1991). Post-traumatic migraine: chronic migraine ­precipitated by minor head or neck trauma. Headache, 31, 451–456.PubMedCrossRefGoogle Scholar
  33. Zemper, E. D. (2003). Two-year prospective study or relative risk of a second cerebral concussion. American Journal of Physical Medicine & Rehabilitation, 82(9), 653–659.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Jennifer Niskala Apps
    • 1
    • 2
  • Kevin D. Walter
    • 3
    • 4
  • Jason S. Doescher
    • 5
    • 6
  1. 1.Department of Psychiatry and Behavioral MedicineMedical College of WisconsinMilwaukeeUSA
  2. 2.Pediatric NeuropsychologistChildren’s Hospital of WisconsinMilwaukeeUSA
  3. 3.Departments of Orthopaedics and PediatricsMedical College of WisconsinMilwaukeeUSA
  4. 4.Pediatric and Adolescent Sports MedicineChildren’s Hospital of WisconsinMilwaukeeUSA
  5. 5.Pediatric Neurology and EpilepsyMinnesota Epilepsy Group, P.A.Saint PaulUSA
  6. 6.Children’s Hospital and Clinics of MinnesotaSaint PaulUSA

Personalised recommendations