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Pediatric Concussion Diagnosis, Management, and Rehabilitation

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Traumatic Brain Injury

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Abstract

Pediatric concussions are a significant public health burden. About 25% of children with a concussion have a delayed recovery, where symptoms can last for over a month. Concussion management is predicated upon prevention, early recognition, avoidance of repeat injury, and instigation of appropriate rehabilitation strategies early after injury in order to minimize the impact of the injury. In this chapter, we will review the epidemiology and pathophysiology of concussion, and then we will focus on the aspects of concussion assessment and management that are most useful to the clinician.

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References

  1. Marshall S, Bayley M, McCullagh S, Velikonja D, Berrigan L. Clinical practice guidelines for mild traumatic brain injury and persistent symptoms. Can Fam Physician. 2012;58(3):257–67.

    PubMed  PubMed Central  Google Scholar 

  2. Voss JD, Connolly J, Schwab KA, Scher AI. Update on the epidemiology of concussion/mild traumatic brain injury. Curr Pain Headache Rep. 2015;19(32):32.

    Article  PubMed  Google Scholar 

  3. Harmon KG, Drezner J, Gammons M, Guskiewicz K, Halstead M, Herring S, et al. American medical society for sports medicine position statement: concussion in sport. Clin J Sport Med. 2013;23(1):1–18.

    Article  PubMed  Google Scholar 

  4. Halstead ME, Walter KD, Moffatt K, Council on Sports Medicine and Fitness. Clinical report: Sports-related concussion in children and adolescents. Pediatrics. 2010;126(3):597–615.

    Article  PubMed  Google Scholar 

  5. Mild Traumatic Brain injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine. Definition of mild traumatic brain injury. J Head Trauma Rehabil. 1993;8(3):86–7.

    Article  Google Scholar 

  6. McCarthy MT, Kosofsky BE. Clinical features and biomarkers of concussion and mild traumatic brain injury in pediatric patients. Ann N Y Acad Sci. 2015;1345:89–98.

    Article  CAS  PubMed  Google Scholar 

  7. Giza CC, Kutcher JS, Ashwal S, Barth J, Getchius TS, Gioia GA, et al. Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurolong. Neurology. 2013;80(24):2250–7.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Carney N, Ghajar J, Jagoda A, Bedrick S, Davis-O’Reilly C, du Coudray H, et al. Concussion guidelines step 1: systematic review of prevalent indicators. Neurosurgery. 2014;75(3):S3–S15.

    Article  PubMed  Google Scholar 

  9. Coronado VG, Haileyesus T, Cheng TA, Bell JM, Haarbauer-Krupa J, Lionbarger MR, et al. Trend in Sports- and Recreation- Related Traumatic Brain Injuries Treated in US Emergency Departments: The National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) 2001–2012. J Head Trauma Rehabil. 2015;30(3):185–97.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention. Rates of TBI-related Emergency Department Visits, Hospitalizations, and Deaths – United States, 2001–2010. (Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention) Retrieved from http://www.cdc.gov/traumaticbraininjury/data/rates.html.

  11. Arbogast KB, Curry AE, Pfeiffer MR, Zonfrillo MR, Haarbauer-Krupa J, Breiding MJ, et al. Point of health care entry for youth with concussion within a large pediatric care network. JAMA Pediatr. 2016;170(7):e160294.

    Article  PubMed  PubMed Central  Google Scholar 

  12. National Hospital Ambulatory Medical Care Survey. Rates of TBI-related Emergency Department Visits by Age Group – United States, 2001–2010. (Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention) Retrieved from http://www.cdc.gov/traumaticbraininjury/data/rates_ed_byage.html.

  13. Canadian Institute for Health Information. More than 90% of ED visits for sport-related brain injuries receive a concussion diagnosis. (Canadian Institute for Health Information) Retrieved from https://www.cihi.ca/en/types-of-care/specialized-services/ed-visits-for-sport-related-brain-injuries.

  14. Cheng TA, Bell JM, Haileyesus T, Gilchrist J, Sugerman DE, Coronado VG. Nonfatal playground-related traumatic brain injuries among children, 2001–2013. Pediatrics. 2016;137(6):1–9.

    Google Scholar 

  15. Norton C, Nixon J, Sibert J. Playground injuries to children. Arch Dis Child. 2004;89(2):103–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Rivers RP, Boyd RD, Baderman H. Falls from equipment as a cause of playground injury. Community Health (Bristol). 1978;9(3):178–9.

    CAS  Google Scholar 

  17. Illingworth C, Brennan P, Jay A, Al-Rawi F, Collick M. 200 injuries caused by playground equipment. BMJ. 1975;4(5992):332–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Yarnell P, Ommaya AK. Experimental cerebral concussion in the rhesus monkey. Bull N Y Acad Med. 1969;45(1):39–45.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Wilde EA, Newsome MR, Bigler ED, Pertab J, Merkley TL, Hanten G, et al. Brain imaging correlates of verbal working memory in children following traumatic brain injury. Int J Psychophysiol. 2011;82:86–96.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Slobounov SM, Zhang K, Pennell D, Ray W, Johnson B, Sebastianelli W. Functional abnormalities in normally appearing athletes following mild traumatic brain injury: a functional MRI study. Exp Brain Res. 2010;202:341–54.

    Article  PubMed  Google Scholar 

  21. Vagnozzi R, Tavazzi B, Signoretti S, Amorini AM, Belli A, Cimatti M, et al. Temporal window of metabolic brain vulnerability to concussions: mitochondrial-related impairment—part I. Neurosurgery. 2007;61:379–88.

    Article  PubMed  Google Scholar 

  22. Chamard E, Théoret H, Skopelja EN, Forwell LA, Johnson AM, Echlin PS. A prospective study of physician-observed concussion during a varsity university hockey season: metabolic changes in ice hockey players. Part 4 of 4. Neurosurg Focus. 2012;33(E4):1–7.

    Google Scholar 

  23. Len TK, Neary JP. Cerebrovascular pathophysiology following mild traumatic brain injury. Clin Physiol Funct Imaging. 2011;31:85–93.

    CAS  PubMed  Google Scholar 

  24. Len TK, Neary JP, Asmundson GJ, Candow DG, Goodman DG, Bjornson B, et al. Serial monitoring of CO2 reactivity following sport concussion using hypocapnia and hypercapnia. Brain Inj. 2013;27:346–53.

    Article  PubMed  Google Scholar 

  25. Creed JA, DiLeonardi AM, Fox DP, Tessler AR, Raghupathi R. Concussive brain trauma in the mouse results in acute cognitive deficits and sustained impairment of axonal function. J Neurotrauma. 2011;28:547–63.

    Article  PubMed  PubMed Central  Google Scholar 

  26. De Beaumont L, Théoret H, Mongeon D, Messier J, Leclerc S, Tremblay S, et al. Brain function decline in healthy retired athletes who sustained their last sports concussion in early adulthood. Brain. 2009;132.(Pt 3:695–708.

    Article  PubMed  Google Scholar 

  27. Chistyakov AV, Soustiel JF, Hafner H, Elron M, Feinsod M. Altered excitability of the motor cortex after minor head injury revealed by transcranial magnetic stimulation. Acta Neurochir(Wien). 1998;140:467–72.

    Article  CAS  Google Scholar 

  28. Chistyakov AV, Soustiel JF, Hafner H, Trubnik M, Levy G, Feinsod M. Excitatory and inhibitory corticospinal responses to transcranial magnetic stimulation in patients with minor to moderate head injury. J Neurol Neurosurg Psychiatry. 2001;70:580–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Nardone R, Bergmann J, Kunz A, Caleri F, Seidl M, Tezzon F, et al. Cortical excitability changes in patients with sleep-wake disturbances after traumatic brain injury. J Neurotrauma. 2011;28(7):1165–71.

    Article  PubMed  Google Scholar 

  30. Tremblay S, de Beaumont L, Lassonde M, Théoret H. Evidence for the specificity of intracortical inhibitory dysfunction in asymptomatic concussed athletes. J Neurotrauma. 2011;28:493–502.

    Article  PubMed  Google Scholar 

  31. Barlow KM, Crawford S, Brooks BL, Turley B, Mikrogianakis A. The incidence of postconcussions syndrome remains stable following mild traumatic brain injury in children. Pediatr Neurol. 2015;53:491–7.

    Article  PubMed  Google Scholar 

  32. Guskiewicz KM, Weaver NL, Padua DA, Garrett WE Jr. Epidemiology of concussion in collegiate and high school football players. Am J Sports Med. 2000;28(5):643–50.

    Article  CAS  PubMed  Google Scholar 

  33. Iverson GL. Misdiagnosis of the persistent postconcussion syndrome in patients with depression. Arch Clin Neuropsychol. 2006;21(4):303–10.

    Article  PubMed  Google Scholar 

  34. Guskiewicz KM, Register-Mihalik J, McCrory P, McCrea M, Johnston K, Makdissi M, et al. Evidence-based approach to revising the SCAT2: introducing the SCAT3. Br J Sports Med. 2013;47:289–93.

    Article  PubMed  Google Scholar 

  35. Walkinshaw E. iPhone app an aid in diagnosing concussions. CMAJ. 2011;183(14):E1047–8.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Brooks BL, Khan S, Daya H, Mikrogianakis A, Barlow KM. Neurocognition in the emergency department after a mild traumatic brain injury in youth. J Neurotrauma. 2014;31:1744–9.

    Article  PubMed  Google Scholar 

  37. Khetani AM, Brooks BL, Mikrogianakis A, Barlow KM. Incorporating a Computerized Cognitive Battery Into the Emergency Department Care of Pediatric Mild Traumatic Brain Injuries – Is it Feasible? Pediatr Emerg Care. 2018 Jul;34(7):501–6.

    PubMed  Google Scholar 

  38. Brooks BL, Daya H, Khan S, Carlson HL, Mikrogianakis A, Barlow KM. Cognition in the emergency department as a predictor of recovery after pediatric mild traumatic brain injury. J Int Neuropsychol Soc. 2016;22:379–87.

    Article  PubMed  Google Scholar 

  39. McCrea M, Iverson GL, Echemendia RJ, Makdissi M, Raftery M. Day of injury assessment of sport-related concussion. Br J Sports Med. 2013;47(5):272–84.

    Article  PubMed  Google Scholar 

  40. Zemek RL, Barrowman N, Freedman SB, Gravel J, Gagnon I, McGahern C, et al. Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED. JAMA. 2016;315(10):1014–25.

    Article  CAS  PubMed  Google Scholar 

  41. Beauchamp MH, Ditchfield M, Babl FE, Kean M, Catroppa C, Yeates KO, et al. Detecting traumatic brain lesions in children: CT versus MRI versus Susceptibility Weighted Imaging (SWI). J Neurotrauma. 2011;28(6):915–27.

    Article  PubMed  Google Scholar 

  42. McCory P, Meeuwisse W, Johnston K, Dvorak J, Aubry M, Molloy M, et al. Consensus statement on concussion in sport: 3rd International Conference on Concussion in Sport held in Zurich. J Athl Train. 2009;44(4):434–48.

    Article  Google Scholar 

  43. Barlow KM, Crawford S, Stevenson A, Sandhu SS, Belanger F, Dewey D. Epidemiology of postconcussion syndrome in pediatric mild trauamtic brain injury. Pediatrics. 2010;126(2):e374–81.

    Article  PubMed  Google Scholar 

  44. Choe MC, Babikian T, DiFiori J, Hovda DA, Giza CC. A pediatric perspective on concussion pathophysiology. Curr Opin Pediatr. 2012 Dec;24(6):689–95.

    Article  PubMed  Google Scholar 

  45. Yeates KO, Kaizar E, Rusin J, Bangert B, Dietrich A, Nuss K, et al. Reliable change in postconcussive symptoms and its functional consequences among children with mild traumatic brain injury. Arch Pediatr Adolesc Med. 2012;166(7):615–22.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Kirkwood MW, Yeates KO, Taylor HG, Randolph C, McCrea M, Anderson VA. Management of pediatric mild traumatic brain injury: a neuropsychological review from injury through recovery. Clin Neuropsychol. 2008 Sep;22(5):769–800.

    Article  PubMed  Google Scholar 

  47. Ganesalingam K, Yeates KO, Ginn MS, Taylor HG, Dietrich A, Nuss K, et al. Family burden and parental distress following mild traumatic brain injury in children and its relationship to postconcussive symptoms. J Pediatr Psychol. 2008;33(6):621–9.

    Article  PubMed  Google Scholar 

  48. Gioia GA. Multimodal evaluation and management of children with concussion: using our heads and available evidence. Brain Inj. 2015;29(2):195–206.

    Article  PubMed  Google Scholar 

  49. Thomas DG, Apps JN, Hoffmann RG, McCrea M, Hammeke T. Benefits of strict rest after acute concussion: a randomized controlled trial. Pediatrics. 2015 Feb;135(2):213–23.

    Article  PubMed  Google Scholar 

  50. Barlow KM. Postconcussion syndrome: a review. J Child Neurol. 2016 Jan;31(1):57–67.

    Article  PubMed  Google Scholar 

  51. Babcock L, Byczkowski T, Wade SL, Ho M, Mookerjee S, Bazarian JJ. Predicting postconcussion syndrome after mild trauamtic brain injury in children and adolescents who present to the emergency department. JAMA Pediatr. 2013;167(2):156–61.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Hessen E, Anderson V, Nestvold K. MMPI-2 profiles 23 years after paediatric mild traumatic brain injury. Brain Inj. 2008;22(1):39–50.

    Article  PubMed  Google Scholar 

  53. Schneider KJ, Meeuwisse WH, Nettel-Aguirre A, Barlow K, Boyd L, Kang J, et al. Cercovestibular physiotherapy in the treatment of individuals with persistent symptoms following sports related concussion: a randomized controlled trial. Br J Sports Med. 2014;48:1294–8.

    Article  PubMed  Google Scholar 

  54. Schneider K. Sport-related concussion: optimizing treatment through evidence-informed practice. JOSPT. 2016;46:613–6.

    Article  PubMed  Google Scholar 

  55. Schneider KJ, Iverson GL, Emery CA, McCrory P, Herring SA, Meeuwisse WH. The effects of rest and treatment following sport-related concussion: a systematic review of the literature. Br J Sports Med. 2013;47:304–7.

    Article  PubMed  Google Scholar 

  56. Alsalaheen BA, Mucha A, Morris LO, Whitney SL, Furman JM, Camiolo-Reddy CE, et al. Vestibular rehabilitation for dizziness and balance disorders after concussion. J Neurol Phys Ther. 2010;34(2):87–93.

    Article  PubMed  Google Scholar 

  57. Galetta KM, Morganroth J, Moehringer N, Mueller B, Hasanaj L, Webb N, et al. Adding vision to concussion testing: a prospective study of sideline testing in youth and collegiate athletes. J Neuroophthalmol. 2015;35:235–41.

    Article  PubMed  Google Scholar 

  58. Master CL, Scheiman M, Gallaway M, Goodman A, Robinson RL, Master SR, et al. Vision diagnoses are common after concussion in adolescents. Clin Pediatr. 2016;55(3):260–7.

    Article  Google Scholar 

  59. Thiagarajan P, Ciuffreda KJ, Capo-Aponte JE, Ludlam DP, Kapoor N. Oculomotor neurorehabilitation for reading in mild traumatic brain injury (mTBI): an integrative approach. NeuroRehabilitation. 2014;34:129–46.

    PubMed  Google Scholar 

  60. Potter S, Brown RG. Cognitive behavioural therapy and persistent post-concussional symptoms: integrating conceptual issues and practical aspects in treatment. Neuropsychol Rehabil. 2012;22:1–25.

    Article  PubMed  Google Scholar 

  61. Gagnon I, Swaine B, Friedman D, Forget R. Exploring children’s self-efficacy related to physical activity performance after a mild traumatic brain injury. J Head Trauma Rehabil. 2005;20:436–49.

    Article  PubMed  Google Scholar 

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Acknowledgments

The work was supported by the Alberta Children’s Hospital Research Institute, University of Calgary, and Canadian Institutes of Health Research, as well as the dedicated staff from the Alberta Children’s Hospital Traumatic Brain Injury Team, Alberta Children’s Hospital Traumatic Brain Injury Rehabilitation and Research Program, the Integrated Concussion Research Program, and the Calgary Childhood Complex Concussion Clinic.

Conflict of Interest

The authors have no conflicts of interest to disclose. The views expressed in this chapter are those of the authors alone.

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Authors and Affiliations

  1. Alberta Children’s Hospital, Department of Pediatrics (Neurology), Calgary, AB, Canada

    Tina L. Samuel

  2. Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia

    Karen M. Barlow

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  1. Tina L. Samuel
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  2. Karen M. Barlow
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Correspondence to Karen M. Barlow .

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  1. The University of Tennessee Health Science Center, Memphis, TN, USA

    Jack W. Tsao

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Samuel, T.L., Barlow, K.M. (2020). Pediatric Concussion Diagnosis, Management, and Rehabilitation. In: Tsao, J. (eds) Traumatic Brain Injury. Springer, Cham. https://doi.org/10.1007/978-3-030-22436-3_19

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  • DOI: https://doi.org/10.1007/978-3-030-22436-3_19

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