Evidenced Based Assessment and Treatment of Children with Mild Traumatic Brain Injury and Adolescents with Mild Traumatic Brain Injury


Barry Willer


Gerard Gioia
John Leddy
Christina Master
Shari Wade



Mild traumatic brain injury (mTBI) presents with varying constellations of symptoms and trajectories of recovery. Neurobehavioral deficits include impaired attention, memory, executive dysfunction, and emotional dysregulation. Research findings on the physiological changes that accompany mild traumatic brain injury (mTBI) include increased resting heart rate, decreased heart rate variability, dysregulation of cerebral blood flow and reduced cardiac output during exercise. Disturbances in the vestibular/balance and oculomotor visual systems also occur following concussion. These deficits have implications for children and their return to function.

Each of these signs and symptoms constellations can have a particular impact on returning to school as well as recreational play and organized sports. Pre-injury learning, attention and psychiatric disorders may further complicate differential diagnosis as well as symptom resolution. The management of persistent post-concussion effects present a particularly difficult conundrum for clinicians. This workshop will discuss evidence supporting specific therapeutic approaches to such patients and highlight the relevance of physiological changes to the autonomic nervous system (ANS) and vestibular oculomotor system and as well as premorbid and family factors to recovery. We will examine emerging evidence regarding interventions and environmental factors that may alter these symptom trajectories.

The research on the physiology of injury has led to a change in mindset about assessment and treatment of mTBI. For example, physicians are now encouraged to conduct a physical exam in addition to a symptom-based assessment. They are also encouraged to view mTBI as having varying effects and therefore not as a singular disorder. Differential diagnosis of subtypes of mTBI and targeted treatments are major foci of this workshop, with discussion of the uniqueness of diagnosis and treatment of children and adolescents with mTBI.

Presenters in this workshop are leaders in research and clinical practice with paediatric mTBI. Their expertise ranges from awareness of specific changes in the ANS to cognitive, emotional and social issues for the child and his/her family. This workshop will also focus on the special issue of communication with children and adolescents and their parents. Didactic presentations will be supported by case studies and practical examples.

Tentative Outline of Didactic sessions:

  • Introduction (Topic and Speakers)
  • The Science of Concussion 
  • Exercise intolerance as a bio-marker
  • Emerging evidence of cognitive intolerance
  • Translating Science into Practice
  • Physical Exam and Vestibular Oculomotor Assessment
  • Special issues in assessment of children and adolescents
  • Targeted Treatment
  • Dealing with return to school 
  • Return to Play for Children and Adolescents


Learning Objectives:

  1. Identify signs of mTBI that are directly related to changes in the autonomic nervous system and autoregulation of cerebral blood flow.
  2. Understand the concepts of exercise intolerance and cognitive intolerance as biomarkers of mTBI.
  3. Identify at least five major differences between children and adults in the assessment, diagnosis and treatment of mTBI