Is There an Optimal Time to Initiate an Active Rehabilitation Protocol for Concussion Management in Children? A Case Series. Issue 3 (May 2018)

• Record Type: Journal Article
• Authors: Dobney, Danielle M.; Grilli, Lisa; Kocilowicz, Helen; Beaulieu, Christine; Straub, Meghan; Friedman, Debbie; Gagnon, Isabelle J.
• Is Part Of: Journal of head trauma rehabilitation. Volume 33:Issue 3(2018)
• Publication Date: 2018-05
• Subjects: brain concussion -- exercise therapy -- mild traumatic brain injury -- postconcussion syndrome; Brain damage -- Patients -- Rehabilitation -- Periodicals; Brain damage -- Periodicals; 617.4810443
• DOI: 10.1097/HTR.0000000000000339
• Languages: English
• ISSNs: 0885-9701

Abstract

Abstract : Objective: To estimate the time frame during which initiating an active rehabilitation intervention (aerobic exercise, balance, and sport specific skills) after concussion contributed to improvement in symptoms at follow-up in children and adolescents who are slow to recover (symptoms persisting beyond 2 weeks) from concussion. Setting: Concussion clinic at a tertiary care pediatric teaching hospital. Participants: A total of 677 children and adolescents with concussion aged 7 to 18 years. Design: Case series of participants starting active rehabilitation less than 2, 2, 3, 4, 5, or 6 or more weeks postconcussion. Main Measure: Symptom severity measured by the 22-item Post-Concussion Scale (PCS)-revised. Results: All patients experienced significant improvement of symptoms while participating in active rehabilitation, irrespective of the start time postonset. Patients initiating active rehabilitation at 2 ( P < .001) or 3 ( P = .039) weeks postinjury demonstrated lower symptom severity at follow-up than those starting at 6 weeks or later. Patients starting at 2 weeks had lower symptom severity than patients starting less than 2 ( P = .02), 4 ( P = .20), or 5 weeks postinjury ( P = .04). Lastly, patients starting less than 2 and 6 weeks or more postinjury yielded equivalent outcomes. Conclusions: The findings support the use of active rehabilitation in children and adolescents who are slow to recover from concussion. Participants starting active rehabilitation less than 2 weeks and up to 6 or more weeks postconcussion demonstrated significant symptom improvements, but improvement was observed in all groups, regardless of the time to start active rehabilitation.