RESUMEN
PURPOSE: To assess which pediatric patients experiencing persistent post-concussive symptoms (PCS) benefit most from multidisciplinary treatment including specialists in Neurology, Neuropsychology, Physical Therapy, and Athletic Training, and to explore the effectiveness of this approach. METHODS: A retrospective chart review of 56 adolescents 10-20 years old (M = 15.0 ± 2.1) receiving multidisciplinary care for PCS (>30 days) was conducted. RESULTS: Systolic blood pressure and Body Mass Index predicted time to concussion resolution (p < .05), such that higher values were associated with slower resolution. PCS scores significantly decreased between participants' initial and final clinic visits, p < .01, and among the 25 participants for whom pre-intervention PCS scores were available, symptom severity scores significantly declined following multidisciplinary intervention compared to pre-referral values (p < .01). CONCLUSIONS: Exploratory analyses reveal that multidisciplinary treatment is a promising approach for reducing symptoms among adolescents with PCS, and that those with greater levels of physical fitness may benefit most.
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Conmoción Encefálica , Síndrome Posconmocional , Adolescente , Adulto , Conmoción Encefálica/terapia , Niño , Humanos , Síndrome Posconmocional/terapia , Estudios Retrospectivos , Adulto JovenRESUMEN
Objective: To describe the challenges related to COVID-19 affecting pediatric neuropsychologists practicing in inpatient brain injury rehabilitation settings, and offer solutions focused on face-to-face care and telehealth.Methods: A group of pediatric neuropsychologists from 12 pediatric rehabilitation units in North America and 2 in South America have met regularly since COVID-19 stay-at-home orders were initiated in many parts of the world. This group discussed challenges to clinical care and collaboratively problem-solvedsolutions.Results: Three primary challenges to usual care were identified, these include difficulty providing 1) neurobehavioral and cognitive assessments; 2) psychoeducation for caregivers and rapport building; and 3) return to academic instruction and home. Solutions during the pandemic for the first two areas focus on the varying service provision models that include 1) face-to-face care with personal protective equipment (PPE) and social distancing and 2) provision of care via remote methods, with a focus on telehealth. During the pandemic,neuropsychologists generally combine components of both the face-to-face and remote care models. Solutions to the final challenge focus on issues specific to returning to academic instruction and home after an inpatient stay.Conclusions: By considering components of in-person and telehealth models of patient care during the pandemic, neuropsychologists successfully serve patients within the rehabilitation setting, as well as the patient's family who may be limited in their ability to be physically present due to childcare, illness, work-related demands, or hospital restrictions.
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Betacoronavirus , Infecciones por Coronavirus/terapia , Trastornos del Neurodesarrollo/rehabilitación , Neuropsicología/tendencias , Pandemias , Neumonía Viral/terapia , Telemedicina/tendencias , COVID-19 , Niño , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Pacientes Internos/psicología , Masculino , Trastornos del Neurodesarrollo/epidemiología , Trastornos del Neurodesarrollo/psicología , Pruebas Neuropsicológicas , Neuropsicología/métodos , Neumonía Viral/epidemiología , SARS-CoV-2 , Telemedicina/métodosRESUMEN
OBJECTIVE: While reintegration of concussed youth back into sports has been increasingly studied over the past decade, a noticeably lacking yet growing body of research has begun to focus on issues surrounding return to academics or "return-to-learn" (RTL). The objective of this article was to conduct a comprehensive literature review to identify the full range of themes and gaps in the current body of RTL research. STUDY DESIGN: Researchers analyzed PubMed, PsycINFO, and ERIC databases to identify all recent (January 2000 through May 2016) empirical publications on the RTL process following youth concussions. In addition to the database searches, bibliographies of selected manuscripts were hand-searched for additional sources. RESULTS: A total of 35 articles met inclusion criteria. Key themes identified from the RTL literature centered on academic outcomes, physician recommendations, length of time to complete RTL, concussion-related symptom difficulties, and academic accommodations/guidelines. Across these areas, the research was fairly inconsistent in terms of providing clear conclusions, likely because of the small number of studies conducted within these areas as well as variability in methodology and terminology. Gaps in the research include a lack of the following: consensus on RTL protocols, agreement on prescription of cognitive rest, guidance for RTL legislation, understanding of communication between systems of care, concussion-related education for systems of care, evidence-based programs or interventions for RTL, and the impact on RTL outcomes. CONCLUSIONS: Given the inconsistencies in RTL literature, more rigorous research is needed to inform concussion policy and practice to assist with pediatric concussion management. (PsycINFO Database Record
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Conmoción Encefálica/rehabilitación , Recuperación de la Función , Investigación , Instituciones Académicas , Adolescente , Niño , HumanosRESUMEN
OBJECTIVES: To determine teacher knowledge of (1) concussion symptomatology, (2) dissemination preferences, and (3) classroom management practices of student concussions. STUDY DESIGN: A cross-sectional survey assessing concussion-related information was completed by teachers/instructors in the state of Alabama. RESULTS: One-hundred and thirty participants completed the survey. Only a quarter perceived they were "very" or "extremely" confident enough to recognize signs related to a concussion (22.3%), and only 12.4% reported they were "very knowledgeable" about concussions. The majority were able to recognize more common concussion symptoms/challenges: headaches (95.4%), trouble concentrating (86.2%), memory (82.3%), balance problems/dizziness (82.3%), changes vision/hearing (76.2%), difficulty completing tasks (70.8%), difficulty making decisions (66.2%), changes in sleep (61.5%), and fatigue (60.8%); only half recognized emotional symptoms (e.g., mood) or symptoms associated with more prolonged recovery. Concussion informants were school nurses (74.4%), followed by parents (46.2%), students (46.2%), and coaches/athletic trainers (45.4%). A little under half of participants received concussion information as part of their job (41.9%). About 14.1% of teachers reported that someone had come to their school to talk with them as a group about concussions, and 82% felt they needed more information. Of the 37% who taught a concussed student, 83% reported they altered the classroom management strategies. CONCLUSIONS: In general, teachers were able to recognize the more commonly experienced concussion symptoms as well as management strategies. However, they appear to want greater concussion information and training. Given the daily influence of teachers on student tasks involving cognitive exertion, incorporation of formal concussion education for teachers is warranted.
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Conmoción Encefálica/diagnóstico , Conmoción Encefálica/fisiopatología , Información de Salud al Consumidor/métodos , Conocimientos, Actitudes y Práctica en Salud , Alabama , Estudios Transversales , Femenino , Humanos , Masculino , MaestrosRESUMEN
OBJECT Pediatric sports-related concussions are a growing public health concern. The factors that determine injury severity and time to recovery following these concussions are poorly understood. Previous studies suggest that initial symptom severity and diagnosis of attention deficit hyperactivity disorder (ADHD) are predictors of prolonged recovery (> 28 days) after pediatric sports-related concussions. Further analysis of baseline patient characteristics may allow for a more accurate prediction of which patients are at risk for delayed recovery after a sports-related concussion. METHODS The authors performed a single-center retrospective case-control study involving patients cared for at the multidisciplinary Concussion Clinic at Children's of Alabama between August 2011 and January 2013. Patient demographic data, medical history, sport concussion assessment tool 2 (SCAT2) and symptom severity scores, injury characteristics, and patient balance assessments were analyzed for each outcome group. The control group consisted of patients whose symptoms resolved within 28 days. The case group included patients whose symptoms persisted for more than 28 days. The presence or absence of the SCAT2 assessment had a modifying effect on the risk for delayed recovery; therefore, stratum-specific analyses were conducted for patients with recorded SCAT2 scores and for patients without SCAT2 scores. Unadjusted ORs and adjusted ORs (aORs) for an association of delayed recovery outcome with specific risk factors were calculated with logistic regression analysis. RESULTS A total of 294 patients met the inclusion criteria of the study. The case and control groups did not statistically significantly differ in age (p = 0.7). For the patients who had received SCAT2 assessments, a previous history of concussion (aOR 3.67, 95% CI 1.51-8.95), presenting SCAT2 score < 80 (aOR 5.58, 95% CI 2.61-11.93), and female sex (aOR 3.48, 95% CI 1.43-8.49) were all associated with a higher risk for postconcussive symptoms lasting more than 28 days. For patients without SCAT2 scores, female sex and reporting a history of ADHD significantly increased the odds of prolonged recovery (aOR 4.41, 95% CI 1.93-10.07 and aOR 3.87, 95% CI 1.13-13.24, respectively). Concussions resulting from playing a nonhelmet sport were also associated with a higher risk for prolonged symptoms in patients with and without SCAT2 scores (OR 2.59, 95% CI 1.28-5.26 and OR 2.17, 95% CI 0.99-7.73, respectively). Amnesia, balance abnormalities, and a history of migraines were not associated with symptoms lasting longer than 28 days. CONCLUSIONS This case-control study suggests candidate risk factors for predicting prolonged recovery following sports-related concussion. Large prospective cohort studies of youth athletes examined and treated with standardized protocols will be needed to definitively establish these associations and confirm which children are at highest risk for delayed recovery.